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Work with clinicians for collection of ED copays
Of all hospital areas, emergency departments are probably the most problematic when it comes to collections. Not only do patients want to leave as quickly as possible, federal law prevents you from collecting anything before a medical screening examination is completed.
Linda Swanson, registration coordinator at Oshkosh, WI-based Mercy Medical Center, says that when her department first started collecting ED copays, "staff were nervous and uncomfortable asking for these." At a department meeting, staff were coached on how to ask for copays by a guest speaker from a collection agency.
Staff began to realize, says Swanson, that "it truly boils down to how you ask and the tone of voice you use. Also, you need a good working relationship with your ER, so you can work together to ensure all patients are seen by registration prior to leaving."
The ED has switched to bedside registration, so access staff use this to their advantage. "We work with the ER staff to see the patient after the doctor has seen them and they are waiting for tests to be done," says Swanson. "We also do the ER copays at that time. So when the patient has been given their discharge instructions from the ER, they are truly complete for registration as well, and there are no delays to pay."
An electronic board displays the patients currently in ED treatment rooms so access staff can keep track of this information. Conversely, ED staff can tell at a glance whether their patient was already seen by access staff, if the tracking board indicates that "long-form registration is complete."
Linda Smith, manager of patient registration and centralized scheduling at Barnes-Jewish St. Peters (MO) Hospital, says, "When our department began collecting ED copays, the question, 'What makes us successful?' was asked.
"Is it how much money we collect, or is it what percentage we collect?" asks Smith. "Here is where we landed: If Mary registered 20 people in a day, how many could she have potentially collected from?" For example, if an ED patient is admitted to the hospital, has a high acuity, or is a workers' compensation case, copays are not collected. Therefore, of the 20 registered patients, perhaps only 10 were candidates for copay collection.
A spreadsheet was created for each access staff member that tracks total possible collections and the amount actually collected. Top-percentage collectors are recognized with verbal praise, meal tickets, and sent congratulatory e-mails. Previously, a staff member might have been recognized for collecting $2,000, but that figure might not be as impressive if the individual could potentially have collected $9,500.
In addition, the department set a goal to collect 40% of total possible collections. "We post our total collections daily so staff can see our challenge for that month. Now that they know what our goal is, we have seen significant gains in our collection," Smith says.
One challenge for registrars was asking a patient for the copay, as they just didn't feel comfortable doing this. Staff were trained on the appropriate way to ask and, also, when it needs to wait until a later time.
"More ED patients are experiencing greater out-of-pocket expenses and deductibles. We see more and more companies going to a higher out-of-pocket for their employees. They may have had an 80/20 plan, and now they have a 70/30, or a much higher deductible for hospitalization," says Smith. "Our access staff ensure that patients receive information about financial assistance available through the hospital. Our goal is to make sure that all patients are educated about this assistance."
Collecting in the ED is a "huge balancing act," says Smith. "We have to be sensitive to our patients and care for their needs first and foremost."