Are patients given financial counseling in your ED?

If not, you're losing money

Emergency department (ED) collections are notoriously difficult and often slip through the cracks, due to numerous challenges. However, some patient access departments have found a way to overcome those difficulties and give patients financial counseling in the ED.

For years, Chicago-based Swedish Covenant Hospital's registration staff were proactive about notifying patients about their copays and deposits required for self-pay patients. "We would try to counsel patients about their payment responsibilities after they had been seen by the ED physician," says Michael Vigan, ED registration manager. "However, as the ED became busier and the importance of registration became emphasized, counseling patients about their copays and deposits became very difficult. And at times, it was non-existent."

With the support of the hospital's finance team and collaboration with ED physicians and nursing staff, a new process was implemented to capture the vast majority of patients with financial responsibilities in the ED. 

When it has been determined that a patient has a copay/deposit, a note is placed in the patient's chart to notify the ED physician and nurse that the patient must be seen by registration before discharge. Upon discharge, patients are brought back to a "discharge area" staffed by an access services team member to discuss any issues regarding copays or deposits. 

This process is very effective, but a portion of the population is still missed. For this reason, a 60-day ED financial counseling pilot program is underway. This pilot program involves providing financial counseling in the ED while the patient is waiting to be discharged. 

"Since there are patients that bypass our discharge area, there is an opportunity to pursue other patient financial responsibilities, such as deductibles and previous balances," says Vigan.

An ED financial counselor investigates the patient's insurance to determine what financial responsibilities the patient has, as well as any previous balances, once he or she is ready for discharge. For patients with no insurance, the counselor can set up payment plans or help with finding financial assistance. 

"There's so much we can do," says Vigan. "We have found that patients are more comfortable talking about financial issues immediately after their medical issues have been resolved."

The ED financial counselor works primarily during the evening shift and is the "go to" person for any registration issue that occurs. Since outpatient registration closes at 7:30 p.m. and admitting closes at 11 p.m., these duties are handled by ED registration staff.

One of the counselor's responsibilities is performing quality assurance on registrations done in the ED. "It is a collaboration between the lead and myself. She looks primarily at the new employees, and I do random checks with everyone else," says Vigan. "We register between 95 to 150 patients per day, so doing this between two people can be quite a task. But with the work we put in, we have seen a decrease in errors."

During the H1N1 outbreak, the ED saw a big surge in registrations. "Our challenge was to keep up with the registrations as they were coming in," says Vigan. The ED financial counselor arranged for extra staff during these busy times.

The ED financial counselor was promoted from the hospital's registration staff and has experience in almost all areas of access services, including admitting, outpatient registration, financial counseling, surgical scheduling/registration, and ED registration. "This makes her a great person to lead this pilot program. It's also easier to resolve issues when you have thorough knowledge of many areas," says Vigan.

[For more information, contact:

• Michael Vigan, ED Registration Manager, Swedish Covenant Hospital, Chicago. Phone: (773) 878-8200 ext. 5457. E-mail:]