IRS 501(r) regulations enacted in 2014 require hospitals to make reasonable efforts to determine
whether individuals are eligible for financial assistance before engaging in “extraordinary collections actions.”
IntelNet—CaptureNet’s Presumptive Financial Assistance Solution
While many of the presumptive financial assistance systems involve generic scoring solutions developed
from national population datasets, CaptureNet creates a customized model that is much more comprehensive
and accurate. Its custom scoring solution draws vital information from a combination of non-FICO credit
data, externally derived demographic data, and internal hospital records.
Recognizing the limits of other available vendor solutions and the reality that each hospital client has unique
community attributes, IntelNet is tailored to each facility, providing a custom financial assistance solution that
assists hospitals in providing and reporting financial assistance while reducing bad-debt write-offs, improving
patient relationships, and limiting the number of misclassified financial assistance patients through more
accurate modeling. Importantly, IntelNet is objective, unbiased, and provides a sound defense in the event
of an audit or legal challenge.
• Eliminates barriers for patients who might face challenges in completing a traditional financial
• Electronic screening enables hospitals to correctly classify a patient account at any point in the RCM
process prior to bad debt.
• Streamlines administrative procedures.
• Provides a fair, consistent, and auditable evaluation of ability to pay.
• Facilitates legal compliance.
• Helps hospitals deliver on their community benefit
• Improves patient and community relationships and the cost-effectiveness of the RCM process
by forgoing the collections process for individuals who are unable to pay.
• Increases Medicare DSH payment allocations and state “pool” reimbursements.
How IntelNet Works
CaptureNet’s presumptive financial assistance solution automates the process to predictively, proactively and consistently identify patients who qualify for financial assistance under a provider’s Financial Assistance Policy.
Using technology that leverages credit-score-like data, demographic information and social media data, CaptureNet can determine for clients whether patients are likely to qualify for financial assistance.
Additionally, CaptureNet can communicate with patients to inform them of financial assistance debt forgiveness, which benefits both the patient and the hospital. Uninformed patients frequently fear the financial impact of medical services and are often afraid to seek care when they need it. By receiving information about their financial assistance eligibility, patients are less burdened, allowing them to focus on one thing — getting well.
Hospitals Gain from IntelNet’s Presumptive Eligibility Patient Communication
- By better determining financial assistance
eligibility and notifying patients, hospitals can optimize reimbursements from Medicare DSH
and state pools.
- Hospitals are able to maintain patient satisfaction with better communication—all while more efficiently using their early-out and bad debt collection resources to pursue payment from patients who are able and more likely to pay for services.
- With not-for-profit hospitals, enhanced patient communication demonstrates compliance with IRS 501(r) requirements to widely publicize their policies and undertake “reasonable efforts.”
- CaptureNet provides comfort that reasonable efforts have been undertaken prior to “Extraordinary Collection Actions,” such as adverse credit reporting, seeking legal remedies, selling debts, and other actions.
“At any point in the cycle, CaptureNet facilitates the correct assignment of Financial Assistance to those patients who will never be able to afford or to pay their medical bills and enables more timely bad debt collection efforts to be focused on those who are able to pay, thus limiting any impact to net cash.”
Getting Started with IntelNet
For each engagement, CaptureNet uses the nation’s foremost compliance experts to review each client’s Financial Assistance Policy in totality, and to make recommendations to ensure compliance with State/Federal Regulations and to assure the most beneficial outcomes for the hospital and patient.
A significant game-changing differentiator in IntelNet is the development of a customized CaptureNet Financial Assistance solution, using up to two years of historical data from the individual health system’s patient population. This historical data is used to develop and statistically validate the best possible customized solution for assigning Financial Assistance while limiting downstream impact to cash by integrating the unique attributes of each hospital.
After the Financial Assistance custom strategy is developed, CaptureNet continues to work closely with the provider, incorporating the solution into the existing workflow system of the client’s business office operations.
- Determine at what point in the billing process to implement the CaptureNet Presumptive Financial Assistance Solution. e.g., Pre-Statement, 30 Days after First Statement, Pre-Bad Debt (the earlier the better—accelerated reimbursement/patient satisfaction/etc.)
- Make Necessary Changes to the Financial Assistance Policy as Needed
- Use existing data interfaces/dashboards if using CaptureNet’s EBO solution
- CaptureNet can leverage existing system interfaces or BOT technology to post the appropriate financial assistance adjustment after the account has qualified presumptively for financial assistance. This would allow the process to be automated end to end.
- Determine if Hospital wants CaptureNet to also notify patients of financial assessment assistance eligibility.