Software helps hospital boost reimbursements for indigent care

Until recently, Floyd Medical Center was barely getting reimbursed for the medications it was providing to indigent patients. "We were somewhere around the 50% to 56% [reimbursement] range," said Ann Baird, a pharmacy administrative assistant at the 304-bed teaching facility in Rome, Ga. "We were missing opportunities."

After one too many missed opportunities, Baird and her colleagues at Floyd began to look for a new software system that would boost the hospital's reimbursements for indigent patient care. The old system, Baird noted, was unreliable and used outdated drug manufacturer forms that resulted in automatic denials for reimbursements.

"The programs we were using did not have [reimbursement] applications pre-loaded into the software," Baird said. "We would call the company and ask that the applications be pre-loaded and maybe it would happen in a few weeks or maybe it would happen in a few months. They were not very responsive to our needs."

The company's Recovery Maximizer interface system helps hospitals and medical clinics gather the necessary information to process an indigent drug reimbursement application. The system-used by about 70 clients nationwide-identifies patients, drug charges, and patient information from a hospital's internal software systems.

"It's a labor reduction tool," explained Brett Dennis, director of business development for Drug Assistant. "Users can look at the total amount of patient assistance within a [medical] facility. They can look at the drugs being given out and any challenge in the program, or any holdups in the paperwork."

Baird uses the software at least once a week to check on reimbursement applications and replacement medications. "The most important things on this software are the reporting features," Baird said. "I would encourage any [hospital] to use two reports-the outstanding report and the retro report."

The outstanding report shows that a reimbursement application has been submitted but the replacement [medication] has not yet been delivered. Baird said she runs the outstanding report frequently to keep better track of medications owed to the hospital. The retro report shows Baird whether the hospital missed generating an application for a certain drug. "We do the retro report at least once a week so we know we are not missing any opportunities."

Floyd hasn't missed any opportunities since being introduced to Drug Assistant in January 2003. The hospital increased its drug reimbursement rate by 40% during the first year of use and recovered nearly $700,000. Baird said Floyd recovered nearly 100% of its reimbursements during the 2007 fiscal year, collecting $2.3 million from its County Clinic and $382,000 for the care of indigent hospital patients.

"The software was designed originally for indigent outpatient clinics," Baird said. "But we are also using it for indigent inpatient recoveries. It has been a tremendous asset to our hospital."

THE AUTHOR is a writer based in New Jersey.