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"Just ask" appears to be the operative phrase at Boulder (CO) Community Hospital, where the access services department increased the amount of monthly copays collected by more than $50,000 between March and May.
"It was one of those epiphanies," notes Jill Mathews, access services manager. She says the collections effort began in earnest after the department trainer volunteered to fill in for an absent emergency department (ED) registrar. "[The trainer] worked about six hours and asked everyone who came in for a copay," Mathews adds. "That’s what she trained people to do, so that’s what she did. Everyone paid, and she collected hundreds of dollars. She was shocked at how many said, No problem.’"
Up until that time, the hospital had been taking in about $22,000 a month in copays, but had not made collections a real focus, Mathews explains. Much of that money was collected, she notes, because patients said, "I think I have a copay."
After the trainer’s experience, Mathews decided to see what her staff could do. As a result, collections increased from $22,000 in March to about $50,000 in April. In May, the staff collected $77,000. "There was no punitive suggestion," she points out. "It was, Let’s just see what happens.’" Mathews promoted the idea through group e-mails and at staff meetings, and offered a prize — a gift certificate to a bookstore — to the person who collected the largest number of copays.
When staff told her they felt bad about asking people for money in a health care setting, Mathews says, she emphasized that they are actually providing a service. "If we ask at the [point of registration], I told them the patient won’t have to write a check later and put that check in the mail," she adds. "Of course if they can’t pay, they will still get the service, but some people appreciate doing it up front. They don’t have to worry about figuring out what the bill is down the road."
Mathews says she also uses the supermarket example. "I make the joke that you don’t go to the supermarket, get a load of groceries, and say, Just send me a bill.’ The cashier at the supermarket doesn’t feel bad for asking you to pay."
Although it’s time-consuming to tabulate the results for each registrar, the friendly competition provides a challenge, she says. "It’s important to validate for people that they’re doing a good job and to make sure that they know you appreciate it, but that it is part of the job. "I continue to raise the bar for folks," Mathews adds, "to say, Let’s see if we can collect more next month.’" The same ED registrar won the competition in both April and May, she notes.
The way the payment process has worked in the past, Mathews says, is that a patient comes in and receives the service, the account is coded and sent to the billing department, which then bills the insurance company. The insurer sends an explanation back, stating that it will pay a certain amount and the patient copay is this amount, she adds. If the patient has moved during that period or provided a bogus address, the chances of collection plummet, Mathews points out.
As part of the new emphasis on collections, the access staff did research to determine exactly how much the copays were for patients with Kaiser, with which the hospital does a lot of business, and for those associated with other HMOs, Mathews says. "We wanted to show what the copays are for the different departments," she says. "The ED is simple, but for the other [outpatient services] I had my assistant call [the HMOs] and say, for example, Do you have a copay for an MRI [magnetic resonance imaging]?’ We compiled that data and now have an admissions resource book for each staff member to use at the point of service."
Mathews says she found out that most HMOs don’t require a copay for imaging or for laboratory procedures. Copays are collected in advance for inpatients as well, she notes. "The financial counselor calls the insurance company and asks what the copay is when the patient comes in. Then the staff ask for copays as people are leaving the hospital. By that time, the financial counselor has entered [into the computer system] what the copay is."