Fine-tuning ED registration processes
Obtaining accurate, detailed information about a patient's insurance coverage is the goal of any registrar, regardless of the patient's point of entry. Clearly, though, emergency department (ED) patients pose some unique challenges.
Patients may come alone and be unconscious or intoxicated, and children may come without parents. Patients don't always bring insurance cards or other information. Also, patients and family are typically anxious and upset, which in itself makes it difficult to get the necessary information.
"Registering in the ED is always quite challenging," says Linda Swanson, registration coordinator at Mercy Medical Center in Oshkosh, WI. "It's a very fast-paced environment. You never know what will be coming through the doors in the next few minutes."
Still, any glitches in the ED registration process can result in confusing duplicate medical records, claims denials, and unhappy patients.
In cases where the patient is unresponsive and the patient's name is unknown at the time of the short form registration, staff enter this as John or Jane Doe. A new medical record number is assigned.
"Once the identity is known, we then edit our registration and merge the unit/medical record number, so all flow to the same patient record correctly," says Swanson.
If the patient is alone and unresponsive, staff obtain identity information from police or paramedics. Police are asked to search the wallet for identification and insurance information.
"If no insurance is found, we always try Medicare and Medical Assistance via our online eligibility product," says Swanson. "Many times, we'll have luck that way."
If not, staff follow up with patients the following day to see if they are responsive or with family members. "Many times, we'll have the patient on our database in our system. This has the patient's demographic information, including address, marital status, employer, insurance, and next of kin," says Swanson.
Staff use the hospital's online eligibility system or contact the payer to verify that the insurance is still current.
"If you do not obtain the information correctly, it can be a claim denial," says Swanson. "Patients change address and phone numbers so frequently these days that it's then difficult to follow up with the patient if there are issues. We need to be as accurate as we can be up front, when we have the patient with us, so claims are clean."
Also, other departments may need information that is captured by patient access. "The information we obtain also goes to our ER doctors' billing company. So it helps to make sure they get their claim paid, as well as ours," says Swanson.
Unknown patients are challenge
Rainey Guzman, emergency department registration manager at Intermountain McKay-Dee Hospital Center in Ogden, UT, says that if patients are unresponsive and no family is present, "this is a big challenge."
"We have no name to correctly identify the patient in our database," says Guzman. "We do, however, have a process in place to appropriately handle our unknown population."
The database has the patient's clinical information attached to his or her record. "Our process includes combining our 'unknown' record with the patient's actual record. So the clinical information can be attained very quickly, once the identity of the patient has been identified," says Guzman.
The goal is to get the patient's medical record information attached to their "unknown" record as soon as possible, so health care providers have the information. "With an unknown patient or even a known patient who has not been to one of our facilities, we may or may not have that information available," says Guzman.
Regardless, the process is to create an account for the unknown patient, so that whatever needs to be done can be done as quickly as possible. "We use a series of names for this process that we have created beforehand," says Guzman. "Once we identify who the patient is, our process is to consolidate those two records. Then the patient's correct information is readily available."
If the patient has never been to the facility before, the "unknown" record is updated to reflect the patient's true identity. "We also have an arm band process to identify when changes are made to the patients' ID band for lab purposes," says Guzman. "This process has worked really well for us."
[For more information, contact:
Rainey Guzman, Patient Account Services, McKay-Dee Hospital, 4401 Harrison Boulevard, Ogden, UT 84403. Phone: (801) 387-7522. E-mail: [email protected].
Linda Swanson, Registration Coordinator, Mercy Medical Center, 500 S. Oakwood, Oshkosh, WI 54904. Phone: (920) 223-1890. E-mail: [email protected].]
Obtaining accurate, detailed information about a patient's insurance coverage is the goal of any registrar, regardless of the patient's point of entry. Clearly, though, emergency department (ED) patients pose some unique challenges.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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