Remake registrars into financial counselors

Don't be caught unprepared

Healthcare reform will mean registrars will have a much bigger role in financial counseling of "newly eligible" patients, but Pattie Froehling, director of the revenue cycle at North Shore Long Island Jewish Health System in New Hyde Park, NY, isn't waiting for 2014.

"There are going to be more eligible patients, and we're going to be there to help those patients get insured," Froehling says. Registration and financial counseling already have evolved into a "one-step process" for patients, she says.

"If they are a financial assistance patient or eligible for a government program, they are not pushed from person to person," she says. "They are speaking with one person." The minute a patient says, "I can't afford to pay that," the registrar reviews all possible options for the patient, says Froehling. Patients might learn they're eligible for a program that allows retroactive reimbursement, such as Medicaid, but even if this isn't the case, the patient might at least be able to obtain coverage for future services.

"If they are not eligible, we take it a step further and let them know what clinics within the health system are available to them," Froehling says. "They may be eligible for a sliding scale."

The department is standardizing the financial counseling processes used at the hospital and provider's offices. "Right now, one practice may refer a patient without insurance to a clinic, and another practice may make a payment arrangement or do something different," explains MaryAnn Murphy, the organization's director of revenue cycle management. "We want to have consistent processes across the spectrum."

Underinsured might qualify

If the family members express financial hardship at Cook Children's Medical Center in Fort Worth, TX, they are referred to a financial counselor for assistance, says Andrea Ayala, a financial counselor in patient registration. Staff members do a quick pre-screen to determine if the patient is possibly eligible for assistance, and then they transfer the patient to a financial counselor who initiates the process.

"The role of the financial counselor is to confirm the family resides in the hospital service area, determine any extenuating circumstances, and inform the family of other forms of assistance," says Ayala. Counselors tell parents which documents are required to complete applications for assistance.

Many families are underinsured and might qualify for Medicaid secondary, Medicaid Supplemental Security Income, the Medicaid Excess Income program, Emergency Medicaid, or charity care for out- of-pocket costs, says Ayala. "Financial counselors also work all self-pay or non-insured scheduled outpatient and inpatient procedures, and initiate contact with the family," she says.

Froehling makes a point of avoiding scripting when coaching registrars to discuss finances with patients. Instead, she expects staff to, in their own words, convey the message, "We'll work with you."

"Every situation is different. You can't script something to relieve a person's anxiety," says Froehling. "A registrar saying something robotically is the last thing you want."

Registrars often find that patients need extensive education about their benefits. "People get on the defensive when they don't understand something," Froehling says. "It relieves them when they know what they have to pay. Then they can focus on their care."


For more information on financial counseling in patient access areas, contact:

• Andrea Ayala, Financial Counselor, Patient Registration, Cook Children's Medical Center, Fort Worth, TX. Phone: (682) 885-7113. Fax: (682) 885-6060. Email:

• Pattie Froehling, Director, Revenue Cycle, North Shore Long Island Jewish Health System, New Hyde Park, NY. Phone: (718) 470-4338. Fax: (718) 470-7421. Email:

• Katie Harwood, CHAM, Admissions Manager, Financial Advocates and ED Registration, University of Utah Health Care, Salt Lake City. Phone: (801) 585-5567. Email:

• MaryAnn Murphy, Director, Revenue Cycle Management, North Shore Long Island Jewish Health System, New Hyde Park, NY. Phone: (631) 414-1576. Email:

• Jack Smarr, MHA, Associate Director, Revenue Management, UK HealthCare, Lexington, KY. Phone: (859) 227-4921. Email: