Self-pay patients are converted to some type of coverage 62% of the time at West Valley Medical Center in Caldwell, ID, reports patient access director Jennifer Bette. The department uses these approaches:
• An onsite Medicaid vendor converts qualifying self-pay patients to Medicaid or disability coverage.
“This is worth the investment,” says Bette.
• Financial counselors work with scheduled surgical patients prior to arrival and visit in-house patients prior to discharge to make payment arrangements.
“Highly effective financial counselors can have a significant effect on upfront cash collections,” says Bette. Collections increased by 15% in two months after the department added two well-trained financial counselors. “Registration staff lacking in collections were held accountable,” adds Bette.
• Patient access uses an accurate estimate tool.
“This provides financial counselors the information needed to communicate the patient’s expected portion and work out a payment,” says Bette.
If an elective patient is unable to pay at least 30% of their portion upfront, financial counselors send a form with all the vital information to Bette. “If needed, based on the dollar amount, I’ll get the CFO’s input,” she says.
Bette reviews the expected insurance reimbursement, compared to what the patient owes, as well as the physician involved, the procedure, and the patient’s payment history. In some cases, patient access contacts the physician’s office to ask if the procedure is urgent.
“If not, we may ask to reschedule the patient to a time when they can pay,” says Bette. “We never use the term ‘canceled.’ It’s always ‘rescheduled.’”
ED is most challenging
About a third of patients presenting to West Valley Medical Center’s emergency department (ED) are self-pay.
“These are most challenging, because they arrive unprepared to pay for services,” says Bette.
ED registrars need to know what wording to use, how to estimate the patient’s charges, how to check benefits, and how to communicate the patient’s portion. “Training and the proper tools on how to collect from ER patients is the best way to ensure all available dollars are secured,” says Bette.
ED registrars use the AIDET process:
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Acknowledge the patient;
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Introduce themselves;
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Let the patient know the estimated Duration of the encounter;
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Explain what they’re doing;
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Thank the patient.
“By preparing the patient for a discussion related to their financial responsibility, the patient has time to think about how they’ll pay,” says Bette. At the end of the encounter, the ED registrar informs the patient of their portion due and asks, “How would you like to take care of that today?”
“If the patient states they are unable to pay, the registrar contacts the on-site Medicaid vendor or the financial counselor,” says Bette.
For patients who fall into the gap of being over income and unable to qualify for Medicaid, ED registrars offer a payment plan. “For those who are able to pay but refuse, they, of course, will end up in collections,” says Bette.
• Jennifer Bette, Patient Access Director, West Valley Medical Center, Caldwell, ID. Phone: (208) 455-4010. Email: [email protected].
