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Nonemergency surgical prepayments

Patient Access Weekly Advisor, December 26, 2007

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Although asking your registrars to request money up front from patients is not a new concept, it is one that access departments have yet to master.

Hospitals, for the most part, do not hire registrars to ask for money, so the subject may be uncomfortable for your staff to broach. And the absence of technology that can immediately provide the amount of money that the patient is responsible for muddies the collections process.

That's why some organizations are picking a dollar figure and asking all patients to pay it up front.

MeritCare, North Dakota's largest health system, located in Fargo, requests all patients who schedule nonemergency surgery to pay $270 before the service. MeritCare didn't apply a scientific equation to arrive at the $270 up-front collection amount.

"It's low enough that we wouldn't get into refunds, and patients could manage paying it, yet enough to make a financial statement," says Karen Dufty, patient access manager at MeritCare."We split that amount between hospital and physician fees."

Training access staff to ask for the $270 is another challenge to the process.

"We try to explain to them the reasoning behind this project, and if something doesn't flow well we can try a script that's more comfortable," Duffy says.

"These are people who are very good registrars," she adds. "They know how to ask for the demographic and insurance information, but not for money. And there are varying degrees of comfort level. We keep them aware of everything that's going on, and we update them on total dollars collected weekly."

The access staff also tries to inform the patients about the benefits of paying before the day of the surgery.

MeritCare has learned that only 50% of its patients prefer to pay before the day of the surgery. "We want that number to be at 75%," says Dufty. "When you are checking in for a surgery, [paying the $270] just adds time." Plus, patients would likely feel more comfortable without the added worry of a payment on a day when they are probably already feeling apprehensive.

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