Advance copay reminder boosts hospital collections

Patients get lead time to plan’

South Shore Hospital in Weymouth, MA, is collecting thousands of dollars more each month, thanks to a new initiative aimed at making sure patients are aware — in advance — of their copays. Since May 2003, a financial counselor has been calling maternity patients — more recently all elective inpatients are being called — and informing them of the copay required by their insurance, says Betty Wisgirda, CHAM, director of patient access. Many patients don’t check the details of their insurance; they just know they have it, she notes.

"We have a large maternity program, and these patients are focusing on the baby-to-be, not their insurance," Wisgirda adds. "We’ve taken it upon ourselves to educate them. I hate to see these young people go home and realize they have a $1,000 copay. We’ve actually had some of the maternity patients’ [bills] go to bad debt."

"It was more that they didn’t understand and weren’t prepared," she notes, "and when the baby is there, there are so many more calls for those dollars."

Some HMOs, which are pervasive in Massachusetts, also charge a copay for the baby, which doubles the patient’s financial responsibility, Wisgirda says. Starting at about the sixth month of pregnancy, she explains, "we call them, say, We’ve checked your benefits and eligibility, and this is what you owe.’ We want to give them enough lead time to plan, to think about how to budget for this if they need to." Some don’t need to, she adds, and just say they’ll pay the copay at discharge. In other cases, Wisgirda says, the hospital arranges a payment plan. The patient also is given the option of paying by credit card.

Although people initially were surprised that the hospital was calling to ask them for money, she says, "they’ve been very responsive when we explain the size of the copay and say we want to make sure they’re aware of it. We’re giving them a chance to do it in advance of the procedure."

The financial counselor makes the call in advance of every elective admission — not just OB cases — and on every insurance, Wisgirda notes. Although she didn’t have firm totals at the end of October 2003, Wisgirda estimates the hospital is collecting about $25,000 a month as a result of this initiative. "Before, we weren’t collecting anything." By eliminating, in many cases, the need to bill patients after the fact and wait 30, 60, or 90 days for payment, she notes, the hospital is receiving its payment earlier, when it is more valuable.

Tracking system aids ED collection

Thanks in large part to a tracking system whereby patients’ names are color-coded depending on their treatment status, the successful collection effort also is taking place in the emergency department (ED), Wisgirda says. "We have a tracing system in the ED, so that when a patient has been seen by a physician, a physician’s assistant, or a nurse practitioner, the unit coordinator changes the color on the patient’s name in the system," she explains. "The financial counselor knows the person has been seen and can go in and collect the copay."

The tracking system, a product of the Wakefield, MA-based vendor PicisMSM, allows different views of patient information for different employees, Wisgirda notes. "The financial counselor has a view that brings over the insurance information." The counselor knows that in worker’s compensation cases or if the injury is the result of an accident, she doesn’t have to speak with the patient, Wisgirda adds. With insured patients, she says, the financial counselor can see via the tracking system either the amount of the patient’s copay, or how to check the person’s eligibility to obtain that figure. "She knows to go in [to the treatment room] and what [payment] to ask for."

Before the clinician’s screening of the patient, Wisgirda notes, registrars do an initial registration, which may be completed at various points in the service continuum, and get the person’s name, date of birth, and other demographic information so that an account number and medical record number can be entered into the system. "They just can’t talk about payment," she adds.

Effort paying off

As a result of the ED collection effort, which began about the same time as the inpatient initiative, the hospital now is collecting an estimated $15,000 per month, Wisgirda says. As with the inpatient copays, nothing at all was being collected previously.

Buy-in from nurses has been crucial to the success of South Shore’s ED collection program, she notes, and the tracking system is particularly important, because of the hospital’s widespread emergency operation. "There is a pediatric ED, the main ED has three sections, and there’s also an observation unit, so we have a lot of geography," Wisgirda notes. The color-coding capability allows staff to communicate quickly and easily regarding patient status, she notes. "We also use the [tracking system] for a lot of other things. If [the system shows that] a patient is going to be admitted, for example, then you see that person first."

[Editor’s note: Betty Wisgirda can be reached at (781) 340-8222 or by e-mail at Elizabeth_Wisgirda@sshosp.org.]