20% increase in ED copay collection
Emergency department (ED) copay collections increased 20% after a process was implemented at Washington Adventist Hospital in Takoma Park, MD, that required patient access reps to perform a benefit check on patients presenting with insurance.
“This process not only helps with receiving insurance payments; it also allows the patient access rep to know how much they are to collect for the ED copay,” says Carole L. Sraver, director of patient access.
Once the patient has been seen by the physician, the patient access rep completes a full registration, at which point insurance information is gathered and the benefit verification is completed. Checking a patient’s benefits allows access staff to know if the patient has insurance coverage, and if not, staff members can discuss payment and qualifying for medical assistance or charity, explains Sraver.
At first, many clinical staff thought it was inappropriate to collect money, and some made comments to staff. “They would notify me so that I could have a one-on-one conversation with the department director and/or the clinician in question, to address any concerns they had about the process,” says Sraver.
Resistance from clinical staff “was an obstacle in the beginning,” she acknowledges, but patient access leaders explained to staff the importance of being paid for care provided. These steps are taken for ED patients at Washington Adventist Hospital:
• During the full registration that occurs after the patient has been seen by a qualified medical professional, members of the patient access staff ask the patients about their insurance coverage.
• If insurance information is provided, the rep does a benefit verification, and if there is coverage and a copay, the patients are asked to pay at that time.
• If the patients don’t have insurance, another rep screens the patients for medical assistance eligibility.
“Should the patient qualify, that process is then set in motion,” says Sraver. “If the patient will not qualify, the patient access rep begins the conversation of making a payment and/or paying in full.”
• If it is determined through conversation that the patient is not able to pay, he or she is provided with a charity application that must be completed in full before a determination can be made.
ED collections are a focus of the patient access department at University Health System in San Antonio, TX, says Juliet De Leon, director of patient access. “Our department is restructuring workflow in coordination with the clinical department, to ensure all patients are processed through our dismissal area upon discharge,” De Leon says.
The clinical staff has agreed to include registration as part of their dismissal workflow. “Communication between our groups is vital in the ED,” De Leon says. “We have also initiated use of electronic notification flags, within a shared application viewable to both registration and clinical staff, to notify clinical staff when dismissal is required.”
This process helps when trying to complete information for trauma patients, says De Leon, adding that patient access leaders and the ED regularly meet to discuss ways to improve teamwork. “We have also purchased wireless phones for staff to ensure communication is uninterrupted while processing registration in various areas within the ED,” says De Leon.
Electronic alert flags were set up to advise clinicians when more information is required from patients. “Even though many emergency patients are unable to pay at the time of service, we want to ensure meeting with all patients prior to discharge to discuss funding,” says De Leon.
Emergency department (ED) copay collections increased 20% after a process was implemented at Washington Adventist Hospital in Takoma Park, MD, that required patient access reps to perform a benefit check on patients presenting with insurance.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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