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Tools for ED collections: Verify coverage now
"I can't pay today." "That's ridiculous. I never had to do that before." "Just bill me for it."
These statements are commonly heard by emergency department (ED) registrars, reports Lauree M. Miller, director of patient access at Catholic Health Initiatives in Lincoln, NE.
However, Miller says that these responses are becoming less common because patients are becoming accustomed to being asked for payment. "We sincerely listen to patients. Then, we offer an explanation," she says.
Because it's difficult to estimate ED charges at the time of the patient's visit, only copays are collected, Miller says. The actual charges aren't always known at the time the patient leaves the ED, she says. "If a patient comes in with a fall injury and gets an X-ray and a CT scan, those charges might not be entered by the time the patient leaves," she explains.
Also, the patient's deductible might change by the time he or she receives a bill, Miller adds. "By the time our bill goes out the door, the insurance company may have paid off more bills from their physicians," she says. "It's a snapshot in time, so the patient's deductible could change from day to day."
Registrars now are using an insurance eligibility verification tool, telling them within seconds if the patient's coverage is valid and the amount of the ED copay, reports Miller. "We only have it set up right now for our top 10 payers," she says.
When the hospital system set out to increase its point-of-service cash collection, the inability to verify a patient's eligibility at the time of registration was identified as a major stumbling block, says Miller. "We wanted to put more resources on the front end in capturing that information, rather than getting a denial on the back end," she says. "We know that when the patient leaves us, the chance of us getting that information significantly declines."
If a patients give an expired insurance card, staff member are able to ask them whether they have another card or whether they changed plans recently, she says. "We can at least have a conversation," says Miller. "Staff can say, 'It looks like you are not eligible. This expired on Dec. 31 of 2010. If we run it through, it will come back as a denial.' The patient doesn't want a surprise, either."
It might be that the patient does have coverage but it needs to be updated, she adds. "It may be that the subscriber is the patient and not her spouse," she says.
If the patient says he or she can't pay the entire ED copay, staff will ask the patient to pay something, says Miller. "We take a conservative approach, but people are getting used to us requesting payment," she adds. "It's not as big of a surprise as it might have been six months ago."