Access Management Quarterly: Registrars’ cash incentive raises hospital collections

Brown County General Hospital more than doubled its upfront cash collections over the past year by offering incentives to both registrars and their bosses, says Barb Dailey, patient access director at the Georgetown, OH, facility.

Fifteen registrars who cover the admitting, outpatient, and emergency areas at the 50-bed hospital had collected close to $15,000 by mid-November 2002, compared to $7,000 for the year 2001, and $5,000 during 2000, Dailey says. The goal for 2002 was $10,000, she adds.

In January 2002, the hospital began offering registrars 3% of whatever they collect in upfront copays and deductibles, she explains. Dailey and a supervisor each get 1.5% of the total collected. Clinic fees charged by the specialty physicians in the hospital’s outpatient pavilion are included, she says. "We keep track of it through the business office. Receipts are printed out in the system and added up at the end of each quarter. [The business office staff] figure up the bonuses and [registrars] get them with their paychecks."

Depending on the assertiveness of the registrar, and to a large extent, the shift and area in which he or she works, those bonuses can be as little as $2 or $3 or as much as $40 or $50, Dailey notes. "Those on third shift don’t collect much, because they don’t have as many patients to see."

Registrars make note of insurance cards to see the kind of plan to which patients belong, she says. They have suggested scripts to use during collection efforts, which include statements such as "How would you like to pay your copay today?" and "We accept checks, credit cards, or cash," Dailey adds.

Hospital administrators are looking toward an eventual bonus payout on $100,000 in collections, she says, which probably would be close to 100% of the money due, according to Dailey. "Our biggest trial is to get patients used to paying up front. We’ve posted signs saying that if you’re a self-pay [patient] or have a copay on an MRI [magnetic resonance imaging], payment is expected up front. That is starting to help."

In some cases, patients actually want to pay but can’t because the appropriate amount has not been determined, Dailey notes. "We’re hoping that we can set a figure of $50 or so [to be paid] toward whatever the deductible is. We’re coordinating with information systems and patient financial services on the charges [for various procedures]."

Upfront collections in the emergency department (ED) alone have increased by about 80%, Dailey says, in part because of a change in the triage process that occurred during the quarter that ended June 2002. The new procedure, she adds, was implemented after careful examination of the provisions of the Emergency Medical Treatment and Labor Act.

After the nurse triages the patient and determines that his or her condition is not an emergency, Dailey explains, registrars are free to register the person and collect the copay. In the past, she says, registrars waited until the end of the ED visit to attempt to collect the payment. "That didn’t work because the patients never got back to us. Now we get them before they go back to be treated."

Most patients have a set copay for ED treatment, Dailey notes. "If it’s a 20% deductible, we don’t try to collect those." Eventually, however, the hospital plans to work out the deductibles and collect accordingly, she says.