The trusted source for
healthcare information and
Many emergency department (ED) registrars don’t make any attempt to collect patients’ out-of-pocket responsibilities, even if patient access does so successfully in other hospital settings, according to revenue cycle experts interviewed by Hospital Access Management.
"Many hospital systems, especially those with lagging collection practices who do not want to risk being out of compliance or on the evening news, avoid collecting in the ED," says Ketan Patel, a senior manager in the healthcare provider segment of strategy and operations for New York City-based Deloitte Consulting.
However, hospitals that don’t collect in the ED "potentially leave millions of dollars on the table and at risk," says Patel. In the ED, however, "often the directive from leadership is to not ask — to only accept payment if the patient offers, or simply inform them of their liability without an attempt to collect," he explains.
ED collections, therefore, are "one of the largest drivers of patient liability write-offs," says Patel. Due to requirements in the Emergency Medical Treatment and Labor Act (EMTALA), registrars are restricted as to when they can approach patients to collect liabilities. (See related story, p. 99, on training patient access staff in ED collections.) "As budgets continue to get squeezed, staff shortages and appropriate coverage in the ED is a challenge," adds Patel. "This often leaves collections as a low-priority function." Additional out-of-pocket costs, such as deductibles, are typically unknown to ED registrars. These amounts go uncollected, says Patel.
Cherie Patterson, CHAA, CHAM, patient access operations manager at Greater Baltimore (MD) Medical Center, says, "In the ED, we have no idea what the patient’s total visit cost will be." The department doesn’t collect deductibles or coinsurance from ED patients, and it has no plans to do so.
Patel says, "Aside from copays on insurance ID cards, many EDs have limited tools to determine other out-of-pocket costs."
ED collections accounted for almost 40% of total point-of-service collections at Greater Baltimore Medical Center in 2013, reports Patterson.
"We started collecting in the ED back in 2008 and have made a few tweaks to our process over the years," she says.
The department implemented a quality assurance tool (AuditLogix, manufactured by Plano, TX-based DCS Global) to determine eligibility and identify copay amounts due. "Before we started using the tool, we collected 3,754 co-pays — around $250,000 in total collections," Patterson says. "Now we’re collecting more than double that amount." In fiscal year 2014, patient access employees collected 8,071 copays from ED patients, which totaled more than $680,000.
The department integrated its credit card processing system with the tool, so staff don’t have to log onto two websites for each patient registration. "Our ultimate goal with ED collections is to make the process as seamless and convenient as possible," says Patterson.
The timing of financial conversations in the ED, in relation to assessment and treatment of the patient, "is especially important," says Julie Ingraham, senior director at Huron Healthcare, a Chicago-based company specializing in revenue cycle improvement. "It needs to be coordinated carefully with the clinical team."
Patient access staff need to know if the patient has been properly assessed, if the patient has been treated, and whether there are any special circumstances that would prevent a conversation about the patient’s financial situation.
"Create communication channels between the clinicians and the financial counseling and registration staff, and mechanisms for the clinicians to pass on information about the patient to the collections staff," advises Ingraham.
Requiring patients to "check out" at discharge windows gives ED registrars another opportunity to collect liabilities, says Patel.
It’s important to connect with the patient after they have been treated but before he or she leaves, emphasizes Ingraham. "Often, the best mechanism is a handoff from the clinician to the financial counselor and/or registrar," she says. "This can be done either virtually through a system or through incorporating the collections staff into the discharge process."
Before patients can exit the ED at University of Utah Hospital in Salt Lake City, they must pass the financial counseling desk. Nurses bring patients to the discharge desk and introduce them to a financial counselor. Ischa Jensen, MHA, CHAA, supervisor of financial counseling and inpatient access services, says, "This allows for a one-on-one interaction with the patient to discuss ED plan coverages."
The process is convenient for clinical staff and the financial counselor, and ED collection goals have increased between 5% and 10% each year. "It has led to much success," says Jensen. "We collected $295,722 in the ED for fiscal year 2014."