Wait times and collections are the two things that annoy patients the most, according to Orville Henry, patient access manager at MedStar Union Memorial Hospital in Baltimore.

As for long waits at registration areas, those are a continual challenge. “They’re directly related to staffing and varying patient volumes,” Henry says.

Surges in volume inevitably occur on the same days registrars call out sick, leaving registration areas short-staffed. “Patients often complain to staff at our information desk,” Henry says. Some ask for a manager; if so, Henry apologizes for the wait, explains the situation, then registers the patient himself. Most leave the registration area in a much calmer state.

However, unexpected out-of-pocket costs are a more serious challenge. “Patient access staff are tasked with collecting time-of-service fees and copays. These encounters are difficult for patients and staff,” Henry says, noting that bad timing can exacerbate the problem. “Patients are often upset because their out-of-pocket costs were never discussed before their surgery being scheduled.”

Education and information help a great deal in these situations. When a registrar asked for a $1,500 payment for a shoulder surgery, the patient insisted he owed nothing at all. The registrar patiently explained that the procedure’s specific CPT code was used to determine the cost, which was based on the patient’s coverage. The patient insisted it was incorrect and asked for a manager.

“I explained the calculation and how it was achieved,” Henry recalls. The procedure was covered at 80%, and the patient was responsible for 20% of the cost. A payment plan was offered, but the patient declined this option. “Once the patient understood the calculation and explanation of coverage, they paid the amount in full,” Henry says.

The key to defusing tension involving collections is to pay attention to the specific patient’s issue, just as registrars would in any other situation. “One patient may need assistance ambulating and require transportation assistance,” Henry says. “Another may require the assistance of our financial advocates.”