Tools allow registration staff to collect deductibles in addition to collecting copays
There is increased likelihood that patients will pay
Patient access employees at San Diego-based Sharp HealthCare are seeing many more patients with high-deductible plans.
"Here is what we know about that population: A patient’s propensity to pay decreases as the deductible size increases," says Gerilynn Sevenikar, vice president of patient financial services. According to the hospital’s data, if a patient owes $500 or less, there is a 68% chance of collecting, but this number drops to 36% if the balance is $5,000 to $6,000.
"This tells the hospital recovery story for our high out-of-pocket patient," says Sevenikar. "Our experience has been that patients that have the capacity to pay, will pay, if they feel like the conditions are fair."
Patient access leaders at Vanderbilt University Medical Center in Nashville, TN, soon will implement new technology to improve emergency department (ED) registration and point-of-service collections. "In August 2014, our ED implemented a phased project for increasing our point-of-service collections," reports Marsha Kedigh, RN, MSM, director of admitting and ED registration.
Patient access worked closely with senior clinical and administrative leaders and the Department of Finance to implement the project’s first phase. Previously, only copays were collected. "We now ask for deductibles from our insured patients," says Kedigh. "We also changed what we asked for from our uninsured population."
Staff members usually asked self-pay patients to pay $300. Now, they ask for amounts ranging from $300 to $3,000, depending on the patient’s acuity. "We looked at six months worth of charges for each acuity level and average out the amount," Kedigh explains.
An outside clearinghouse is used to determine the amount to be collected. "We know that the deductible amount may not be exact," she says. "We inform the patient that if we collect too much on the deductible, they will be reimbursed the difference."
If the deductible is high, staff members collect a partial payment. This amount is applied first toward the copay, with the remainder applied toward the deductible. "Our challenge is with the outside clearinghouse vendor," says Kedigh. "It is not consistent with reliability and what is brought back." In some cases, staff members have to consult the payer website to determine the patient’s deductible.
"We have been very successful with this first phase," reports Kedigh. "So far, we have seen a 50% increase in our collected amount."
Mobile devices needed
During the second phase of the ED collections project, registrars will collect at the bedside. "This will require new technology, as in mobile devices for credit card payments," says Kedigh.
Patient access worked with the hospital’s legal counsel and ED clinical leaders on the timing of when registrars can enter the room to collect, to ensure compliance with the Emergency Medical Treatment & Labor Act. "We have all agreed on when," says Kedigh. "Now it is a matter of putting time parameters around registration staff getting to the room, collecting, and getting out, so as not to delay discharge and getting others out of the waiting room and into a room."
Members of the hospital’s information technology department shadowed patient access staff members to get a better understanding of the current workflow. "The ideal is to have all rooms equipped with stationary laptops," says Kedigh. These would automatically post what amount was collected into the hospital’s billing system and print receipts for the patient.
For the time being, Kedigh purchased a mobile credit card swipe device for about $800.
"I plan on using this device as a pilot to work through the process and flow of doing bedside collections," she reports.