ED collections surge when asking for copays

Just a couple of years ago, registrars in the emergency department (ED) at the University of Connecticut Health Center in Farmington collected only $100 to $1,000 a month in copays.

"We were doing very poorly collecting any kind of dollars in the ER," says Gail Melingonis, director of patient access.

Now, monthly ED collections range from $15,000 to $18,000, which is something Melingonis credits primarily to simply asking patients for their copay.

ED patients were once very resistant to being asked for money, she explains, but this question has become the norm. "There were not too many hospitals in our area asking for those copay dollars, but they're starting to do it now," she says.

Before starting the new copay collection process, says Melingonis, registrars were given training in how to ask for payment, and how to respond to various reactions from patients. These changes were made:

If an ED patient is self-pay, registrars ask for a set amount of $250.

"If the patient says they can't pay it, we always ask them, 'What can you pay?'" says Melingonis. "We ask that staff make a good effort to ask the patient to give us something."

To be sure that registrars have accurate information about the patient's insurance status and copay amounts, the department invested in online eligibility checking.

Registrars now tell patients, "Your insurance is stating that you have a copay of $100. How would you like to pay that today?" "We don't ask them if they want to pay. We ask them how they want to pay," says Melingonis.

Patients no longer seem surprised by this question, because EDs are asking for copays nationwide now, she says. "In the beginning, we had lots of patients tell us, 'You've never asked me for that before,'" Melingonis says. "If a patient does say that, we explain that policies have changed."

If a patient is unable to pay, registrars make sure they are aware that this won't stop them from getting the best possible care.

"If they have no insurance, we can quickly financially screen them and assist them in filling out forms so they can get on Medicaid and also our charity care program," says Melingonis.

When an ED patient arrives, a "quick triage" is performed by the medical staff to determine if the patient is going back right away to a treatment room, in which case the triage nurse does a "mini-reg."

If the patient is quick-triaged and can return to the waiting room, a complete registration is done.

"Under EMTALA [Emergency Medical Treatment and Labor Act] laws, we do not discuss finances until the patient is properly triaged," says Melingonis. "We would ask for payment later, at the bedside or at discharge."

After patients are discharged, the medical staff directs the patient to the discharge desk.

"We ask for the money at that point," says Melingonis. "We have gotten help from the medical staff to lead the patient out to the right place."

Previously, she explains, patients were rarely asked for a copay because a clinical person handled registration. "Since it was a medical person, they didn't focus on the financial aspect. They just wanted to treat the patient, as they should," Melingonis says. "We have put business people in the registration role now."

If the patient doesn't pay anything, registrars document the reason given.

"We hold them accountable for notating, for instance, that the patient stated he didn't have his wallet or that a patient said she can't afford to pay anything at all," says Melingonis. "This way, the information can be tracked."

At times, staff members do struggle in asking sick or worried patients for money, Melingonis acknowledges. "We give staff positive reinforcement by reminding them that this is the new trend. It helps the patient know where they stand, and it's good for the hospital," she says. "They don't always like it, but they know it's their job, and they do the best they can."