In 2008 and 2009, Sharp HealthCare saw a $3.4 million drop in self-pay net revenues. The region's increase in unemployment inversely aligned with cash collection, says Gerilynn Sevenikar, vice president of patient financial services for the San Diego-based system.

In an effort to stop the bleeding, Sevenikar reached out to the Foundation for Health Coverage Education, a San Jose, Calif., nonprofit that helps people nationwide find health insurance. The two organizations began an initial 30-day trial in which all self-pay patients entering four Sharp emergency rooms were given the FHCE eligibility quiz, a tool that asks patients without insurance five questions to help determine their eligibility for public or private health insurance. Once completed, a personalized list of coverage options is produced, many of which allow hospitals to collect retroactively for care provided.

"We started with just a brochure and then began hyperlinking to FHCE's website and the questionnaire," Sevenikar explains. The quiz is housed on the Foundation's CoverageForAll.org website.

After just the first month, the results were so outstanding that Sharp decided to make the practice a permanent part of its financial screening process. "They couldn't believe how many options we were able to find for people by just doing this really quick five-question eligibility quiz," says Ankeny Minoux, president of FHCE.

As of the end of October — 19 months into the program — the results have been impressive: 80.4 percent of patients entering Sharp emergency rooms didn't know they were eligible for private, free or subsidized government insurance coverage.

With virtually no startup costs or required staffing changes, FHCE now hosts a Sharp-specific screening module that electronically interfaces with the hospitals; the results of each quiz are automatically uploaded to Sharp's patient accounting system.

The new data captured provide Sharp with an overview of a patient's financial status, program eligibility and account history, enabling staff to take a more active role in helping patients enroll in various programs for which they are eligible. It's also helped them make more informed decisions about how to establish payment options.

"If I know someone is only at 300 percent of the poverty level, my approach to that person with respect to what they're truly able to pay is going to be completely different than if I don't know that information at all," Sevenikar says.

The best part: As of the close of fiscal 2011, Sharp has recouped the $3.4 million deficit it ran for 2008 and 2009, as well as an additional $500,000. "We are thrilled," Sevenikar says.