New access director looks at ED collection

Effect on charity programs considered

Lori Judge, MS, HAS, director of patient financial services at St. Claire Regional Medical Center in Morehead, KY, offers some feedback on her hospital’s efforts at cash collection in the emergency department (ED).

"At this time, we have decided to route all ED patients back through registration when their visit is finished," says Judge, who assumed her position in November 2002. "This way, the patient has already been triaged and seen by a physician."

There are one or two registrars in the ED at any one time, she adds. "They have set up a system so that when they register a patient, they note payment next to the person’s name."

When a patient’s visit is finished, Judge says, he or she goes to the registrar, who looks up the person’s name and tells him or her that the hospital will bill Medicare, Medicaid, or an insurance company. In the case of self-pay accounts, the registrar asks for some payment toward the cost, she notes.

"The exact amount has yet to be determined," Judge says, "but we were thinking of a set rate for everyone, based on a percentage of the cost of the average ED visit."

Judge is in the process of determining how the new process might impact the hospital’s charity/ indigent funding programs, she says. "I understand we cannot collect any money from patients if we refer them for financial assistance."

Another idea under consideration is hiring a financial counselor for the ED, Judge adds, suggesting that in all likelihood the investment in another full-time equivalent would pay off.

"It makes sense to do that," she notes. "There are a lot of uninsured people who come through the ED, and we’re losing the potential [for collection]."

If the financial counselor determined that a patient was not eligible for financial aid, Judge says, the hospital could attempt to collect some payment toward the bill. "The No. 1 opportunity to collect money is when the person is in front of you. If a patient is self-pay, we might send them a letter [after the visit], but then there is no real incentive for them to pay."

"Any information or suggestions about how others address this issue would be helpful," she says, adding that St. Claire is a rural facility with 159 beds.

[Editor’s note: If you have feedback for Judge, or comments or information to share regarding any access topic, please contact editor Lila Moore at (520) 299-8730.]