Multiple providers seen? Collect multiple co-pays

When patient access leaders at Cincinnati (OH) Children's Hospital Medical Center took a close look at multidisciplinary clinics, it was determined that many of them were collecting a single co-pay even when patients saw multiple providers, says Michelle Gray, MHA, director of patient access and outpatient registration.

"When speaking of co-pays, the multidisciplinary clinics were an area that was overlooked. Now, it is the focus of our attention," says Gray.

Some clinics collected co-pays only for the host department and not for the other providers, says Gray, but they, too, were billing the patient. One reason for this being overlooked was that some of the hospital's multidisciplinary clinics were incorrectly classified, says Gray.

"We generated a spreadsheet to determine how many multidisciplinary clinics we have here at Cincinnati Children's," she says. "We are still adding clinics to that spreadsheet."

Pushback from providers

Patients are accustomed to paying a single co-pay for the entire visit, explains Gray, but if they see multiple providers, then multiple co-pays are due. A patient with a $20 co-pay would owe $80 if he or she saw four providers in the clinic.

Patient access staff now inform patients that by coming to a multidisciplinary clinic, several providers are in one location for their convenience, says Gray. There's no need for patients to go to separate clinics, she explains, but they still need to pay co-pays for each provider they see. "We're working with the business directors to generate a letter to patients, notifying them in advance that they may have multiple co-pays," says Gray. "This has been a slow process, and we are having to deal with provider push back."

Some providers don't want their patients to pay multiple co-pays for a single visit, she says. "It is a payer requirement," Gray says. "Our senior level executives are telling us they want it collected on the front end. There is a cost associated with sending that co-pay bill."

Word has gotten out

Gray has met with the business directors of the host departments to share the new process with them.

"Word has gotten out about the need to collect co-pays," she says. "They know it's coming down from our senior leadership, and they want to cooperate."

There is ongoing discussion about the best way to collect multiple co-pays, says Gray. In some cases, patients don't know which providers they will be seeing during their visit. For example, the vascular malformation clinic includes providers from ear, nose, and throat; hematology; pediatric surgery; and dermatology, but patients don't always see all of these providers. "We collect after the visit, when the clinic knows which providers have seen the patient," says Gray.

One of the biggest challenges is to simply get the patients to stop by the registration desk on their way out. "Sometimes, they just leave," says Gray. "This process requires a collaboration of team members to ensure this co-pay collection on the back end works."


For more information on co-pay collection, contact:

• Michelle C. Gray, MHA, Director, Patient Access/Outpatient Registration, Cincinnati (OH) Children's Hospital Medical Center. Phone: (513) 636-1414. Fax: (513) 636-7531. E-mail: