Vendor outlines steps to providing ED service

New reporting schemes developed

When PATHS LLC took on the job of providing financial counseling to self-pay emergency department (ED) patients at Philadelphia’s University of Pennsylvania Medical Center-Presbyterian, the vendor’s first order of business was to distinguish the new program from work it already was doing for the hospital.

"We were already [providing inpatient services], so we had to separate the two," says Tony DiLuca, a Collingswood, NJ-based principal with the company, which provides accounts receivable solutions to health care providers in New Jersey, Pennsylvania, and Delaware. "This program is just for patients who come to the ED and leave the same day."

"The other things we had to do were to develop some different reporting schemes to allow us to monitor and report, to look at opportunities to expand the program if needed, and to look at financial feasibility," he adds.

When the PATHS representative registers the self-pay patients, DiLuca explains, the company’s own computer and software are used, so that each account is loaded separately into its system. "At the end of the month, if there are 500 patients, we want to make sure we can reconcile, that we have 500 accounts in our system."

PATHS also needs to differentiate between the patients actually seen by a representative Monday through Friday during the 11 a.m. to 7 p.m. shift and those who come in at other times and whose information the company receives via a report, he says. "We have to develop different tags in the system to compare our performance levels for the seen’ vs. the non-seen’ patients," DiLuca adds.

The company gives each ED self-pay patient, whether seen by a PATHS representative, a checklist of what the company needs and what the state needs to qualify the person for coverage, he says. "If we see them, we leave the list. If not, we send out a letter that includes the checklist."

In addition, all patients are provided with the number of a toll-free customer service hot line to call if they are confused and need additional help during the process, DiLuca notes. "We also do follow-up with the state," he adds, "to say, Did Mr. and Mrs. Jones visit or send in their information?’ On the back end, we follow up [regardless if the patient has been seen]. We send out several statements and follow up with a phone call. We also have the capability of doing electronic verification with the state — we check on a weekly basis through the whole population.

"Once we get the approval numbers," DiLuca says, "we provide them to the [Presbyterian staff] so they can do the appropriate billing to Medicaid.

After 90 days, if the patient is still not approved, he says, PATHS closes the file and the hospital follows that case as a bad-debt account.