Cancer copayment assistance programs can be complex to manage, with various rules and regulations that must be followed. Cancer Center Executives must ensure that these programs are run efficiently and effectively in order to help patients afford their treatment and ensure that your revenue is maximized. In this blog post, we’ll explore the challenges of managing cancer copay programs and offer some tips on how to overcome them. Read on to learn more!

The first challenge of managing cancer copay programs is making sure that all of the necessary funds are available to patients. Many patients cannot afford their treatments and need assistance in order to make them financially possible. To ensure that these funds are available, Cancer Center staff must be organized and proactive when it comes to tracking eligibility, submitting necessary documentation, following program rules, and getting appropriate signatures.

Another challenge of managing cancer copay programs is staying up-to-date with the ever-changing regulations. Since laws and regulations are continuously being updated or changed, hospitals must remain aware of any changes in order to ensure that they are compliant with local and federal guidelines. Staying on top of these guidelines can be time-consuming, but it is essential for running a successful program. One of the biggest examples here is ensuring that your federally insured patients realize that they are unfortunately restricted from these programs and therefore not able to benefit the same way as commercially insured patients.

Finally, managing cancer copay programs involves a lot of paperwork and data entry. Hospitals must keep detailed records of application status, bills that have been submitted, checks that have been received and copay cards that have been loaded in order to ensure accuracy and compliance. This can be tedious work, but it is necessary for running an efficient program.

Fortunately, there are some tips that Cancer Center Executives can use to make managing cancer copay programs easier. First, hospitals should partner with an outside organization that can help them manage their program more effectively. These organizations have the experience and expertise needed to ensure that everything is done correctly and in compliance with regulations. Organizations like Qualify Health provide a fully managed service that combines a human layer of service and intelligence to streamline the process of collecting and entering data. They then continue to ensure that all bills are submitted on behalf of the patient and the funds are sent to the hospital.

The key to successfully managing cancer copay programs is staying organized and proactive in ensuring all patients are signed up and accessing the care they need. With the right tools and strategies, hospitals can ensure that their programs are running smoothly and helping as many patients as possible.

Remember, managing cancer copay programs doesn’t have to be a struggle. By utilizing the right resources and staying organized, Cancer Center Executives can ensure that their program is efficient and compliant with all regulations. If you need help managing your program, contact us today for more information. We’re here to help!

Prior authorizations are essential to make sure that a patient’s insurance carrier is going to pay for their treatment. The greatest doctor with the best diagnosis and treatment protocol is ineffective if the patient cannot afford it or if their insurance will not cover it due to a lack of authorization. What causes prior authorizations to be denied, slip through the cracks, or otherwise be left unfulfilled? Here is a case regarding a real patient with their hepatitis C medication.

Patient X had been confirmed to have Hepatitis C and the drug ordered by the prescriber required a prior authorization. The doctor who made the diagnosis recommended a protocol involving Epclusa which, through most insurance carriers, can demand quite a few clinical notes to support the administration of the medication: a check for cirrhosis, a concurrent infection of HBV (hepatitis B), whether or not the patient has tried and failed a similar medication before—just to name a few!

The pharmacy that was to dispense the medication noticed that the drug did require prior authorization (most prior authorizations for outpatient prescriptions start in the pharmacy!) A request was sent to the office and an initial authorization request was sent to the insurer. However, a follow-up fax was sent back with the requesting of additional clinical information – a scan that wasn’t performed yet on the patient’s liver. The staff made an appointment for the patient to come in and the scan was performed. Afterwards, though, the scan was never sent to the insurer and, thusly, the authorization was denied. A follow-up authorization was initiated and, as what happens after most denials, it was immediately denied as the initial authorization was and now an appeal is required.

An appeal is when the office staff, patient, or advocate of the patient claims that the decision to deny was in error and to have the determination overturned. This was strange to the staff because all the criteria matched, they were just trying to send the required information that was asked of them. Part of the prior authorization process is to follow the flow: even though the office staff did everything within their power to advocate for the patient, the idea of an appeal for a medication that fit the indication did not quite make sense, it should be approved!

After three months of back and forth with the insurer, Qualify Health was requested for assistance, able to intervene, find out the proper format for an appeal, accrue and compile the necessary clinical information to support the use of the drug, have a signed attestation from the prescriber that the information provided is verified, and submitted through the proper channels with an URGENT expedite for a faster turn-around! After Qualify’s assistance, the drug was approved for the patient within twenty-four hours with a gracious and appreciative patient that was finally going to get the treatment that they needed.

Ultimately, prior authorizations are, and should be, part of the clinical processes in any office. There should always be a flow, a delegate for duty, and organization for the myriad processes that every insurance carrier requires based on the drug, treatment protocol, or inpatient administration because anything beyond immediately is too long for a patient that requires treatment.

Blog Introduction: Health equity disparities are pervasive and have significant implications on the health and well-being of individuals. These disparities have been attributed to a variety of factors, including financial inequity, lack of access to quality health care, and inadequate public policies that fail to address the needs of marginalized communities. Financial advocacy is a tool that can be used to help reduce these disparities by ensuring equitable access to healthcare services. In this blog post, we will discuss how financial advocacy can help bridge the gap between those who need healthcare services and those who are able to receive them.

What is Financial Advocacy?  

Financial advocacy is an approach that focuses on increasing access to healthcare services for those who cannot afford them or do not have insurance coverage. This includes providing resources such as scholarships, grants, direct subsidies, or other forms of financial assistance that can help patients pay for medical expenses. It may also include helping patients navigate the complex world of insurance coverage so they can receive the care they need without going into debt.

Benefits of Financial Advocacy

Financial advocacy has many benefits for both patients and providers alike. For patients, it increases access to care by reducing out-of-pocket costs and making it easier for them to get the care they need without having to worry about how they will pay for it. For providers, it ensures that all patients are treated equitably and that no one is denied care due to their inability to pay. It also helps providers ensure higher levels of patient satisfaction since their patients will be more likely to complete recommended treatments if they don’t have to worry about paying for them out-of-pocket. Furthermore, financial advocacy has been shown to improve overall health outcomes by reducing delays in treatment due to cost considerations or lack of insurance coverage. This means that by investing in financial advocacy programs, providers can ensure better health outcomes while also improving patient satisfaction rates.   

In Summary, Financial advocacy is an important tool in helping reduce health equity disparitiesBy searching for ways that providers can help source financial assistance directly related to medical expenses, you help to ensure equitable access to healthcare services regardless of a person’s income level or insurance coverage status. This not only improves patient satisfaction but also leads directly leads improved overall health outcomes due reduced delays in treatment caused by cost considerations or lack of insurance coverage. All healthcare providers and hospital executives should look at ways in which their organizations can implement programs to maximize the sourcing of financial advocacy as part of their efforts towards promoting equity in healthcare services across all communities affected by these disparities . 

Blog Introduction: Poor health outcomes due to disparities in healthcare, often based on socioeconomic factors like race and income, can be seen all over the world. These differences in outcomes are due to lack of access to preventive services, diagnosis and treatment, as well as social determinants such as education and housing. To address this issue, financial advocacy has emerged as a potential solution to increase access to quality care.  

What is Financial Advocacy?  

Financial advocacy is a form of patient navigation that links patients with resources and programs that can help them pay for their medical expenses. It also helps individuals understand their rights under their insurance coverage and provides support when they are trying to resolve payment issues with providers or insurance companies. By connecting patients with resources like financial assistance programs and charities, financial advocates provide an additional layer of support for those who need it most.  

The Benefits of Financial Advocacy for Health Equity Initiatives  

The impact of health equity initiatives can be greatly increased by utilizing financial advocacy. For example, many people put off seeking medical attention due to fear of high costs. Financial advocates can help alleviate this fear by linking patients to available resources that can help cover the cost of care. This not only increases access to care but also helps reduce disparities in health outcomes among different socioeconomic groups.  Additionally, financial advocates can help ensure that all individuals receive the same level of care regardless of their ability to pay. By connecting patients with available resources such as charitable funds or sliding-scale payments, financial advocates are able to provide equal access to quality healthcare regardless of individual income levels or insurance status.   

Conclusion:  

In conclusion, financial advocacy is an important tool in solving health equity disparities. By providing additional support for those who need it most, financial advocates play an integral role in ensuring that everyone has access to the same level of care regardless of income level or insurance status. By working together with healthcare providers and other stakeholders, we can make sure that everyone has the opportunity to lead a healthy life free from economic hardship or discrimination due to socioeconomic status.

MT: Tips & Tricks for Physicians to Optimize Prior Authorization

MD: Prior authorization burdens physicians and impacts care. Use PMS and EMR systems to optimize prior authorization, manage denials, and eliminate disconnect.

Introduction

The wait for a prior authorization to be approved can cause patient anxiety and limit their care. However, from the providers point of view, the main focus on the prior authorization is getting it approved so that you can be reimbursed

Managing the patients emotional response to the prior authorization waiting gain can be less stressful if you include a strategy to work with the patient, and communicate with them, setting clear expectations. Implementing these conversations as part of your workflow and optimizing your prior authorization process with a much more streamlined process can result in two outcomes:

1. Lowered patient anxiety
2. Faster time to treatment
3. Improved financial and operational efficiency for your practice

Tips to Optimize Prior Authorization

The process of obtaining prior authorization involves numerous manual steps and parties, resulting in errors. Lengthy medical reviews necessitated by prior authorization may delay care and create confusion for physicians and patients.

You can reduce the time required to treat a patient by automating the entire prior authorization procedure as soon as possible in the revenue cycle. It reduces the likelihood of errors occurring and the quantity of labor that must be performed manually.

Let’s find out the useful tricks to optimize prior authorization.

Utilize Your Electronic Medical Records (EMR) Systems

Start by maximizing the huge investment that almost all providers have made in their EMR’s.. By better utilizing your reporting functionality, you will open up the ability to better track your prior authorizations and where they are in the chain of: Submit / Approved / Denied / Appeal. These reports must, at the minimum, show the date that the authorization is needed and where it is in the process. However, having the report will be of no use, unless you have a set of eyes on it each day, and ensuring that follow ups are occurring, as needed in order to ensure the PA is complete before the patients appointment.

Work on Denial Management

Denial are a burden, but they should also be considered as a learning opportunity. Understanding the cause of your denials will help you prevent them in the future and ensure that future prior authorizations include the necessary documentation to prevent a reoccurrence. Utilizing a reporting system that gives you insight into what transpired will allow you to identify patterns. The next step is collaborating with internal and external expertise that will allow you to create a system that can capture the necessary information in the authorization submission process.

Know and Track your Policies

Most payers put their coverage rules online, they are transparent and accessible. It is important that you continue to monitor revisions and yet keep old policies. The importance of keeping historical policies on record mean that you have access to it, in cases of the need to If a payer wishes to appeal a 2021 rejection, they must use a 2021 policy, but they typically don’t know which one. However, by maintaining historical emails, bulletins, and other insurance-related documents, you have the ability to review them when fighting a denial.

Outsource Prior Authorization to Experts

Given the time and expertise needed for successful prior authorizations, experts are needed. However, because this is a ‘cost center’ practices are induced to assign their lowest cost and lest experienced employee to this role. It will take longer and may lead to errors. In many cases, making the choice or using an outsourced service provider will  save your medical facility money over time, and ease the stress of the prior authorization process. Further, as prior authorization specialists are constantly focused on ensuring that they stay updated on new policies and regulations, it ensures that you are always up to date with the documentation and information that you need to submit.

What is a Copay Assistance Program?

As healthcare costs continue to rise, patients are looking for ways to save on medication costs. Providers want to make sure they get compensated for any patient out-of-pocket expenses due to them. When insurance is not enough to cover the total cost, patients struggling to afford expensive drugs turn to Manufacturer Copay Assistance Programs or Copay Cards to help with the out-of-pocket expenses. Pharmaceutical companies typically offer these programs. The program’s purpose is to help people with commercial or private insurance cover their deductibles, copays, and co-insurance directly related to the cost of their prescription drugs.

How do Copay Assistance Programs work?

Copay Cards reduce the total out-of-pocket expenses for the patient. Once approved for the program, the patient’s insurance is billed first and covers some of the drug’s cost, then the manufacturer covers most, if not all, of the remaining out-of-pocket expense.

How to apply for a Copay Assistance Program?

If your physician practice or specialty pharmacy does not partner with someone like Q Consulting Services, then the patient can access Copay Card programs through the manufacturer’s website. To sign up for the program, they will register online, or call the program to enroll. Once you are enrolled, you are provided with your member information and possibly a credit card to use at your pharmacy or provider’s office– this varies among programs.

If your practice/specialty pharmacy partners with a company like Q Consulting Support Services (QCSS) , we will sign up the patient and maintain their membership, and give you and the patient any information they need.

What are the requirements or restrictions?

For most Copay Card Programs, there are two main requirements:

1. The patient must have commercial or private insurance.

2. You cannot have government health insurance, such as Medicare, Medicare Advantage Plans, or Medicaid.

How to receive reimbursement for out-of-pocket expenses?

There are three possible scenarios:

1. The patient is filling their prescription (e.g., Humira) at the provider or hospital-owned specialty pharmacy. The pharmacist will process the patient’s insurance as the primary payer and the copay card as the secondary payer. The Copay Card Program may cover the out-of-pocket expense in its entirety, or the patient may be responsible for a tiny portion – generally around $5.

2. The patient is receiving an infusion (e.g., Herceptin, Stelara) at an out-patient facility. The facility will bill the primary insurance for the drug. Once the insurance company pays its portion, the explanation of benefits (EOB) will indicate the patient’s out-of-pocket expense. The patient is then responsible for submitting the EOB to the program. When the claim is approved, the program will mail a check or upload the reimbursement to a credit card.

3. QCSS can manage the entire reimbursement process, from electronically receiving the EOB as soon as the billing occurs, to and ensuring that the charge is loaded on the copay card and making sure the physician office is paid by either managing check requisitions or running the copay cards through your POS.

How do patients and healthcare professionals benefit from Copay Assistance Programs?

Copay Assistance Programs lessen the patient’s financial burden, making it easier for them to obtain their prescription and ensure that the appropriate treatment is attainable.

Q Consulting Support Services specializes in the management of Copay Card programs. Our dedicated staff partners with clients ranging from small oncology practices to the country’s largest healthcare systems. Our Support Service team enrolls the patient into the Copay Card Program, monitors and submits EOBs with patient out-of-pocket expenses, and follows-up on any denials to ensure payment is received promptly. Ultimately, increasing patient satisfaction and reducing the financial burden on the provider’s office or facility by guaranteeing patient out-of-pocket expenses are obtained, which reduces bad debt and increases revenue.

How to find Foundation Assistance for patients

Foundation Assistance for Chronic or Life-Altering Diseases

Foundations offer financial assistance to those suffering from Chronic or Life-Altering Diseases when insurance is not enough to cover the treatment. Foundations help fill the gaps by assisting patients with their out-of-pocket expenses.

What is Foundation Assistance, and Who offers it?

Non-profit organizations like The Leukemia & Lymphoma Society, Healthwell Foundation, and the PAN Foundation, to list a few, provide financial assistance to patients in need. These foundations offer specific disease funds and award assistance to patients via grants. The grants awarded may cover copays, deductibles, insurance premiums, co-insurance and may help with travel or household expenses.

Who is eligible for Foundation Assistance?

Available funding is disease-specific – you must be diagnosed with the disease, be actively receiving treatment in the United States, have insurance covering the medication and therapy, and fall within a certain percentage of the Federal Poverty Level Guidelines (FPL). Unlike Manufacturer Copay Assistance Programs, Foundations allow applicants to have Federally Funded insurance like Medicare and Medicare Advantage plans.

If your practice/specialty pharmacy partners with a company like Q Consulting Support Services (QCSS), we will enroll all qualified patients, maintain their enrolment, and manage the entire billing and collections process.

How to apply for Foundation Assistance?

Disease fund availability is dependent upon whether there is sufficient funding available. Funds open and close daily, making the application process more difficult than other financial assistance programs. If a fund is accepting applications, you should apply immediately.

Step 1: Gather Information for the application.

• Demographics (including Social Security Number)
• Diagnosis
• Estimated household financial income
• Insurance information
• Pharmacy contact information
• Treating physician contact information

Step 2:

• Apply online or over the phone.

Alternatively, QCSS can manage the entire process, from enrolling patients as soon as a fund opens and helping them manage their financial paperwork to ensure all claims are submitted and reimbursed promptly.

How much financial assistance can I receive, and how is it paid out?

The award levels range from $100 to over $10,000 per applicant, depending on the fund. The full grant amount is allocated over one year and reimburses for services and treatments rendered during this period via the fund’s reimbursement process.

Keeping your grant active

Foundations want to ensure that grants are being used by those actively receiving treatment and in need of financial assistance. Many foundations require initial reimbursement requests to be submitted within a specific time frame and do not allow extended periods of inactivity, or the awardee could lose the grant completely. The time frames vary between 90-120 days.

Q Consulting Support Services specializes in managing Foundation Grants for our clients. We actively monitor Foundation sites to apply for our patients as soon as a fund opens up. Additionally, we ensure that all reimbursement requests are submitted timely so that our patients do not lose their funding and may continue to pay their providers for services rendered.

How helping patients find financial advocacy improves patient satisfaction and reduces bad debt

How Patient Financial Advocacy Improves Patient Satisfaction and Reduces Bad Debt

Patient Financial Experience

The patient financial experience within the U.S. Healthcare System is unique due to the variety and complexity of the different payer-systems. A patient’s expectation of their medical bill being as straightforward as the treatment should not be unrealistic. However, it is not of this time. In combination with the complex nature of medical bills, the patient’s out-of-pocket responsibility has increased due to high deductible and high-cost sharing insurance plans.

A TransUnion Healthcare analysis revealed that patients are, on average, experiencing at least a 10% increase in average annual out-of-pocket costs, and the average burden on each patient is approximately $2,000 – an unaffordable hurdle for most patients that is leading to millions of dollars of bad medical debt for the average healthcare system.

Given the constant media attention about the burden of healthcare costs, patients are increasingly expecting their practitioner to either help them with patient financial advocacy or absorb some of the patient’s financial burden due to financial hardship. Therefore, it is in the best interest of all parties for the physician/hospital/pharmacy to provide financial advocacy services in tandem with clinical services to improve revenue recovery and patient loyalty.

Patient satisfaction and patient experience are inextricably linked. As patient out-of-pocket responsibility continues climb, the medical practices that take proactive measures to help meet the patient’s financial needs and improve the patient experience will be the practices to prosper.

Any practice that has attempted to provide in-house patient financial advocacy soon comes to realize the administrative burden that it puts on existing staff, and often are required to hire additional FTE’s to manage these programs on behalf of their patients. This is where Q Consulting Support Services steps in.

Q Consulting Support Services specializes in providing Financial Advocacy to help patients with the out-of-pocket expenses associated with treatment. Our dedicated staff partners with clients ranging from small oncology practices to the country’s largest healthcare systems. Our Support Service team applies for funding on the qualifying patient’s behalf through grants and financial assistance programs. After funding approval, we monitor and submit EOBs with patient out-of-pocket expenses, and follows-up on any denials to ensure payment is received promptly. Ultimately, increasing patient satisfaction and reducing the financial burden on the provider’s office or facility by guaranteeing patient out-of-pocket expenses are obtained, which reduces bad debt and increases revenue.

How QCSS was able to secure over $16,000 in financial advocacy for this patient

Patient Overview: Mr. V.

Like many newly diagnosed cancer patients, Mr. V’s life took a frightening detour when he was diagnosed with Locally Advanced Pancreatic Cancer at the age of 56. When he began treatment, he only had Medicare Part A benefits and had recently lost his job due to the COVID-19 Pandemic. His household income, which included his unemployment and his wife’s income, totaled about $2,000 a month, putting him at around 150% of the Federal Poverty Level.

Medication & Cost

The oncologist prescribed our patient Abraxane, Gemzar, and Creon to treat his Pancreatic Cancer and after consultation with Q Consulting Services and the hospital, he learned that his medications were going to cost him more than $12,000 a month, and did not have appropriate insurance coverage to help with the expense. For this couple on a fixed income, the cost would be impossible to cover. It was at this point that the hospital’s oncology business asked Q Consulting Support Services (QCSS) to step in, with the request that we help the patient avoid incurring an untenable amount of debt and assist the hospital in being reimbursed, where possible, for Mr. V’s treatment.

Outcome

The patient worked on getting additional insurance coverage and signed up for Medicare Part B., while QCSS simultaneously secured free drugs for Abraxane and Creon.

QCSS understands that a patient’s focus should be on their recovery while the physicians, nurse and hospital’s focus should be on patient care. With this in mind, we fully managed the entire enrollment, billing, and ordering process throughout Mr. V’s treatment, alleviating our client, The Greater Baltimore Medical Center, and the patient from this added burden. The patient received his medication for free, and our client avoided a potential loss of over $12,000 a month.

Once the patient secured his Medicare Part B insurance, QCSS then obtained a fund through the PAN Foundation to cover his 20% out-of-pocket expenses. Our client would be able to bill and receive reimbursement through Medicare, while our patient’s out-of-pocket costs were also fully covered.

This patient required more assistance due to the circumstances of his unemployment. QCSS provided further assistance by finding alternative funding options like The Good Days Emergency Relief Fund to help this patient with household expenses and utility payments.

Over three months, we were able to secure over $16,000 in financial advocacy for this patient. This patient was so appreciative of our services and the financial assistance we were able to provide through one of the most challenging times of his life. He focused on his health instead of stressing over the burden of expensive healthcare treatment