Special report: Upfront collections

Need support for copay? Back it up with the figures

Security concerns were initial obstacle

If you are interested in instituting a program for upfront collections, it’s a good idea to have some financial evidence to give credence to the proposal, suggests Ellen Byrne, RN, MS, director of patient access services at Community Medical Center Healthcare System in Scranton, PA. In her hospital’s case, Byrne notes, the business office did a report on managed care patients they had billed for copays after a visit to the emergency department (ED). "They tracked who paid and who didn’t," she adds, "and the director of the business office estimated [the hospital] was losing $50,000 a year from those who never did pay."

As part of the hospital focusing attention "wherever money was being lost," Byrne met with a group that included her supervisors, the business office director, the vice presidents of finance and operations, the ED nurse manager, and representatives from security to consider beginning a collections effort at the point of service.

Security personnel were included, Byrne explains, because the main objection being expressed about collecting money in the ED was that registrars might be held up. "The safety of registrars was really the whole concern," she says. "We met and met and met, with everyone voicing concerns," Byrne adds, "but it reached a point where I finally said, We just have to do it.’"

With the decision made, the financial advisor — who reports to Byrne — sat down with ED registrars and went over the procedure, she says. "The financial advisor was knowledgeable about [collecting copays] because she was here when it was tried before. [The supervisor] explained the process of how to pose the question — How do you plan to pay?’ not, Do you plan to pay?’ It was a one-on-one orientation," Byrne adds. Because of the security concerns, the payment choices initially offered were check, Visa or MasterCard, but cash also is accepted now, she notes.

Paying up front

The collection process, implemented in October 2000, is going well, says Byrne, who was awaiting a report from the hospital’s finance department on exactly what improvement has been made. "The staff have been great and the patients have been great," she adds. "Some have offered to pay at the point of registration."

With the help of Washington, DC-based Hworks, which calls itself "an advisory board company," Community Medical Center is looking at the entire revenue cycle, Byrne notes. Collecting at the point of registration is one subset of that effort, she says. One of the pieces of the ED collections process the hospital still is working to perfect, Byrne says, is finding a way to ensure that the patient stops to settle the account before leaving the facility.

"We’re now looking at the process from front to end," she explains. "We inform the patient at the beginning [about the payment procedure], but we don’t collect until the end. The problem is we have two entrances, so the patients can slip out, or there may be a delay at the registration area so they may not want to wait. There’s no process to do a second check [to determine] that they did stop."

The plan, Byrne says, is for the hospital to use Wellsoft, its integrative clinical management system, to alert registrars and nurses that a copay is needed from certain patients. This on-line tracking system — which is displayed on large monitors in the ED — will color-code these accounts, she adds. Registrars will go to those patients and complete the discharge process before they leave the exam room, Byrne notes.

"Our goal is to have everything go back to the patient," she says. "I want to have a cart with a laptop, a receipt receptacle, and maybe a camera that can take a picture of the insurance card."

Another possibility is hiring a financial counselor for the ED, she says. That person, who likely would work a 1 to 9:30 p.m. shift, Byrne adds, would handle a variety of duties associated with self-pay patients.