'Not just another smile' Making registration work
Patients want financial planning 'with no surprises'
By Kari Kemper
Several years ago, I visited my local emergency department with my youngest son. His lip made direct contact with his older brother's head, causing quite a gash.
Entering the ED, my main goal was the well-being of my son. However, working in the health care revenue cycle industry, I was curious to see how this particular ED, which is part of a major hospital system in a large metropolitan area, would handle processing my information and asking for payment.
According to EMTALA, when a patient enters the ED, they must be triaged and in stable condition before any insurance or financial information can be requested by the hospital and verified.
And this particular ED followed EMTALA to the letter. My son was triaged, stability confirmed, and we were sent back out into the waiting room to "register."
Sitting in the registration booth, the registrar asked for my son's name and birth date to pull up his patient record. Accessing his record, she recited the address in the file and asked me if this was accurate.
Knowing that insurance eligibility information was coming next, I handed her my insurance card. She glanced at the card, stated she was sure it was all right, and proceeded to have me sign a few consent forms. I told her that per my card, I have a $50 emergency department copay and that I would like to pay by check or credit card.
She responded that they would bill me.
I told her that I wanted to pay now.
She expressed that the billing department handles this and I need not worry about payment at this time.
I pushed further, telling her that it would be better for me to pay now, and in turn, it would benefit her hospital to have money in hand immediately, thus eliminating the overhead costs of billing.
She would not take my money. Nevertheless, she gave me a nice smile.
Now, this was several years ago. Surely hospitals have caught on, right?
Not so fast.
Yes, insurance eligibility verification and demographic validation are becoming more mainstream in hospitals today. Hospitals that are proactive actually verify insurance eligibility and demographic information in real-time while the patient is scheduling or presenting for treatment by using technology vs. taking the patient's word as confirmation or verifying post-service. However, thanks to consumer-directed health plans with high deductibles and funding cuts to both public assistance and employer-sponsored plans, self-pay is the fastest growing segment of hospital revenue. Patients now expect more information. They no longer want to know only copay figures.
Last December, my physician ordered additional testing for me after a routine office visit, which required making an outpatient appointment with imaging.
I was handed the appropriate paperwork and told to pick up the scheduling phone in the hallway to schedule the procedure. Very convenient.
During this scheduling process, the scheduler asked for my insurance information. As I gave her the information, I asked her what my out-of-pocket cost would be for this event. She said she did not have that information. This struck me as odd as I was using insurance that was part of the hospital system, the provider who made the request was part of the system, and the procedure was a standard procedure that all women experience usually after the age of 40. Calculating the cost, if they had the tools in place, would have been effortless and payment would be in the door earlier. However, the scheduler was quite soothing over the phone. I could hear the smile in her voice.
Checking in at registration a week later, I asked again for my out-of-pocket costs. The registrar said she did not have access to that financial data and wished me well, and all with a smile.
I was ready to pay the copay and out-of-pocket costs immediately, or at a minimum set up a payment plan, and was unable to do so. This hospital missed two opportunities to gather payment from me prior to treatment: at the point of scheduling and at the point of registration.
My experience is not unique. Listening to National Public Radio recently, I heard a story of a woman who suddenly became epileptic after being healthy all of her life. She incurred an enormous amount of bills. However, she is finding that it is almost a full-time job to navigate through the multitude of paperwork sent to her monthly to find out what she needs to pay after insurance, discounts, and write-offs. She still does not understand what she has to pay and has yet to be contacted by the facility that is treating her condition to set up a payment plan or financial counseling. She asked, while at the hospital during her many visits, what her treatments were going to cost her out of pocket and did not receive any financial information. She was told that she needed to contact her insurance company. And when she did talk to her insurance company, they told her that she needed to talk to her provider. Round and round she goes, without any clarification and enormous frustration. The hospital does not receive payment when they need it and worse yet, receives bad PR.
The hospital registration department is the first point of contact for a patient during a very stressful time. Patients have always looked for emotional support during this process, knowing that the registrar will help them register with ease, guiding them to the next level of care. Now, patients are demanding more. Patients want to know how much the procedure will cost them, essentially categorizing health care as a transaction. It is necessary that hospitals change the patient experience on the front end, empowering both the health care industry and the patient, allowing for financial planning with no surprises. The opportunity to educate patients on their financial obligation and collect payment is greatest at the time of service and is increasingly expected.
Entering the ED, my main goal was the well-being of my son. However, working in the health care revenue cycle industry, I was curious to see how this particular ED, which is part of a major hospital system in a large metropolitan area, would handle processing my information and asking for payment.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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