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ED collections management

Compliance Monitor, May 6, 2005

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Q: I'm looking for some examples of how hospitals manage collections in the emergency department (ED). Can you help?

A: I oversee the ED registration staff and financial counselors, and our area is a bit different than the outpatient clinical side. We actually will take copayments before seeing a patient. I know some EDs prefer to wait until the patient leaves, but at that point, it's my feeling that patients just want to go home and would prefer not to stop for more administrative issues.

We phrase it like this: "Your insurance company requires a copayment today of $50. We can take a check, cash, or a credit card."

We like to phrase it this way, so we emphasize that their insurance company is requiring it, not the hospital. Many people just ask to be billed the copayment. Others, due to the nature of an ED visit, tell us they don't have anything with them-so they are billed.

Because of EMTALA regulations, we obviously can't force patients in the ED setting to make a copayment and we never make patients feel like their care is being delayed to take a copayment, nor do we delay their care for that reason.

For patients who come in by ambulance or look quite ill, we don't ask them for copayments. If patients walk in and there is a question of whether they will be admitted, we ask them to stop at the desk when they are discharged from the ED to make copayments; some actually stop to do this, others do not.

We have financial counselors in the ED from 7 a.m. to 10 p.m. Monday through Friday, and also for 20 hours on the weekend. If patients are self-pay, they are directed to the financial counselor and screened for government programs.

This question was answered by Betsy Dorisca, patient access manager, Brigham & Women's Hospital, Boston.

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