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ED collections increase by 75% with new tactics
Present it as a service to patients
No one ever asked me for money before," was a common response when registrars started collecting ED copays at Evanston, IL-based NorthShore University HealthSystem, reports Cindy Geaslin, director of patient registration.
Despite this response, collections in the hospital systems' four EDs have increased by 75% in the past two years. "We now have patients who try to pay their copay when they walk in the door, and of course, we can't take it until their visit is completed," says Geaslin. "People are getting more accustomed to paying for services at the time of service."
Registrars started a pilot for collecting ED copays in the treatment rooms at one of the hospitals two years ago. "We had such a tremendous response that we rolled it out to all four EDs," says Geaslin. "We are taking a more direct approach. Once the patient's visit has been completed, the registration staff visit the patient in their room."
Registrars take 4 steps
A fairly significant percentage of ED patients with small balances went to bad debt, reports Geaslin.
"That was something we wanted to turn around," she says. "If we have you here, and we can get the $50 or $100 from you in a customer-friendly way, that's what we'll do."
Here are the steps taken by registrars:
Staff perform online real-time eligibility checks to determine the amount of the patient's copay.
Registrars make contact with every single patient that potentially has a copay, says Geaslin. "It is now the staff's responsibility to talk to the patient about how they will pay the copay," she says. "That has made a huge difference in the amount of money we are able to collect."
If patients say they're unable to pay their copay, registrars refer them to the hospital's financial counseling department.
"We want patients to get the answers that they need before they walk out the door, when possible," says Geaslin.
Registars are willing to accept partial payments.
Full payment was requested previously, says Geaslin, but this request has changed due to higher ED copay amounts. "We are seeing some copays in the $300 or $400 dollar range, and even some as high as $500 or $600," she says. "If the patient's copay is $150 and they only have $50, we'll accept it as partial payment."
If the copay isn't paid, a reminder letter is sent out the day after service.
The letter reminds the patient that he or she didn't pay the copay when seen in the ED the previous day, says Geaslin. "That gives the patient a chance to send it out right away," she says.
Previously, staff asked patients to stop by the desk on their way out to pay their copay, but registrars now take responsibility for making contact with the patient.
"When patients are discharged from the ED, they are in a hurry to leave," says Geaslin. "We found that most patients were more likely to go through the door than they were to wait in line to pay a copay."
Staff now encourage patient to pay before they leave as they state, "I've verified your insurance. When you're ready to pay, I'll stop by. I'll be happy to take care of your payment." Geaslin says, "They don't have to worry about getting a bill and mailing it back or going online to pay it."
Registrars present copay collection as a service being provided to patients, so they don't have to worry about bills coming in the mail. "They can take the copay and give the patient a receipt while the patient is still in the room waiting for the rest of their paperwork to be generated to be discharged by nurses," says Geaslin. "They don't have to stop out front and wait in another line." (See related stories on incentives, below, and working with clinical staff, p. 68.)
For more information on ED collections, contact:
Cindy Geaslin, Director of Patient Registration, NorthShore University HealthSystem, Evanston, IL. Phone: (847) 982-6747. E-mail: email@example.com.