ED revenue doubles with new process

Eligibility moved upfront

Emergency department (ED) collections jumped from $55,000 to $120,000 annually after eligibility software was implemented at Mary Rutan Hospital in Bellefontaine, OH, reports John E. Kivimaki, director of patient accounts.

“The need to acquire an estimation tool is crucial, since patients continue to see greater out-of-pocket responsibility,” Kivimaki says. “There are also a greater number of self-pay patients coming to ERs. But collecting is harder because of the economy.”

One of the biggest challenges in collecting upfront in the emergency department is simply having the chance to discuss out-of-pocket responsibility with patients, he says. “We have charity programs and other ways to assist the patient in taking care of their unexpected visit,” says Kivimaki. “But most of the time, we have very little time to talk to the patient about these programs.” These practices are used:

• Registrars identify insurance copays upfront as the patient is being registered.

“We can now identify these patient liabilities in the ED, unlike outpatient registration, where we do not have anything to estimate the patient liability after their insurance makes their payment,” says Kivimaki. Registrars in outpatient areas ask for a small deposit, depending on the service, he adds.

• Registrars reference a list of individual copays for all employers in the hospital’s service area.

“This is used mostly on insurances for which we cannot access eligibility and patient copays through our eligibility process,” says Kivimaki.

• Registrars ask self-pay patients for a minimum amount and try to collect something from every patient.

• Incentives are now based on total collections instead of only self-pay collections and co-pays.

“All registrars now can receive incentives on any patient liability amount, including charge-off accounts,” says Kivimaki. “We have also increased the maximum amount of incentive a registrar can earn monthly.”

Incentives also were changed to reward employees based on what the total department collects, as opposed to what individual staff members collect. “As the department total increases, so do the individual incentives,” he says.

• Two financial counselors were added, to consult with patients regarding their out-of-pocket responsibility.

This addition will allow the department to pursue patient liabilities on higher dollar amounts in inpatient and surgery accounts, which weren’t collected previously. “In the ED, the addition of financial counselors means there is potential to collect more co-pays and self-pay liabilities,” says Kivimaki.


For more information on processes involving emergency department patients, contact:

John E. Kivimaki, Director, Patient Accounts, Mary Rutan Hospital, Bellefontaine, OH. Phone: (937) 599-7033, Ext. 7033. Fax: (937) 599-2143. Email: John.Kivimaki@maryrutan.org.