Presumptive Eligibility

Presumptive EligibilityPresumptive Eligibility allows your organization to reduce costs while increasing the benefit to your community. Use options such as the PARO Charity Score to streamline your process.

Automate your presumptive eligibility process and see the following outcomes:

  • Reduce Bad Debt
  • Increase Community Benefit
  • Lower costs to collection companies and other third-party vendors
  • Eliminate duplicate processes for staff
  • Improve patient satisfaction scores uses a flexible framework to streamline your operations.  You choose the appropriate time(s) in your revenue cycle to transition accounts and determine  placement within your organization’s Financial Assistance Program.  Score patients at registration or pre-registration in real-time to determine appropriate workflow. Score patient accounts prior to bad debt and improve community benefit and negotiate better collection rates. Results are placed on easy-to-use worklists for staff or integrated directly into your billing systems to fully automate the process.

ParoSorePARO™ Decision Support, LLC is the pioneer of a classification system to triage accounts for presumptive charity and extended eligibility services which are otherwise routinely lost to bad debt. PARO™ and the PAROScore is a socio-economic predictive model which takes into account the barriers that prevent 25-40% of all patient-pay patients from applying for financial assistance. Revenue cycle leadership refers to this population of patients as “unresponsive.” Patients may be unresponsive for a number of reasons including lack of literacy to understand and complete a traditional application, lack of adequate documentation required under a hospital’s policy, and even the fear that the hospital may deny their application and use the information against them in a collection process.

Presumptive Financial Assistance Eligibility.

There are instances when a patient may appear eligible for charity care discounts, but there is no financial assistance form on file due to a lack of supporting documentation. Often there is adequate information provided by the patient or through other sources, which could provide sufficient evidence to provide the patient with charity care assistance. In the event there is no evidence to support a patient’s eligibility for charity care, [Sample Hospital] could use outside agencies in determining estimate income amounts for the basis of determining charity care eligibility and potential discount amounts. Once determined, due to the inherent nature of the presumptive circumstances, the only discount that can be granted is a 100% write off of the account balance. Presumptive eligibility may be determined on the basis of individual life circumstances that may include:

1. State-funded prescription programs;

2. Homeless or received care from a homeless clinic

3. Participation in Women, Infants and Children programs (WIC)

4. Food stamp eligibility;

5. Subsidized school lunch program eligibility;

6. Eligibility for other state or local assistance programs that are unfunded (e.g., Medicaid spend-down);

7. Low income/subsidized housing is provided as a valid address; and

8. Patient is deceased with no known estate.


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