It’s not a question of whether you should ask patients for copays, but when, say several reimbursement experts. Here are three strategies:
1. Guide patients toward a separate area upon discharge. Use a separate discharge area for final registration and copayments, recommends Michael J. Williams, president of the Abaris Group, a Walnut Creek, CA-based consulting firm specializing in emergency services. "It should be located in an area that is a natural exit from the emergency department (ED). Signage can help with this."
Williams adds that verbal and visual cues to guide the patient to a discharge area are permitted under the Emergency Medical Treatment and Labor Act (EMTALA), as long as the medical screening exam is completed. He suggests giving patients discharge instructions orally, but having them pick up written instructions along with prescriptions in the discharge area.
2. Avoid EMTALA violations. EMTALA requires that there be no delays in the medical screening exam for financial reasons, but having a copay process at the end of the discharge process does not violate this, according to Williams. He recommends the following to avoid violations:
- training and retraining all staff on EMTALA requirements annually;
- educating registration staff on point-of-service collection strategies and tools;
- use of scripting to avoid statements that might be misunderstood by the patient.
3. Discuss copays during registration, but ask patients for payment only at discharge. At Inova Fairfax (VA) Hospital’s ED, insurance information is obtained from the patient during registration, says Melody R. McKeel, senior operations manager for registration and financial services. If a copay is listed on the card, the registrar says: "I see your insurance requires a $50 copay. Please pay this on your way out at our discharge window, after the doctor has discharged you."
No copays are collected at the time of registration, she explains. "We have the luxury of having a discharge window right at the exit of our ED, which helps us tremendously. This enables us to discuss financial issues after the patient has received treatment." At the discharge window, all demographic information is verified, including address, phone, next of kin, emergency contact, date of birth, Social Security number, and insurance information. "We make sure that everything is properly entered so a clean bill is produced," McKeel says. "The people at the discharge information are at a higher [pay grade] level than the registrars, and their focus is quality collections."
Patients are more likely to be willing to give the copay after they have received quality care and good customer service, according to Thom Mayer, MD, FACEP, chairman of the department of emergency medicine at Inova Fairfax Hospital. "We actually end up collecting a lot of copays on the back end’ of the visit."
The ED currently collects 70% of its copays, McKeel says. "We are striving to get up to 85% by working with the ED staff to make sure they ask patients to stop by the discharge window." There is a system in place to follow up with patients who don’t stop at the window, she adds. While checking patients out at the discharge window, the staff takes the opportunity to determine if there is going to be a financial hardship for the patient, says McKeel. "We have several programs we can offer to assist the patient," she says. "If a hardship is identified, we go ahead and complete the required documents at that time."