payment before care of nonemergent pts

  1. About 2 years ago, some hospitals in my city moved towards getting payment from non emergent pts before they received treatment in the ER. The pt would get triaged, then receive a "quick medical screening " from a qualified medical professional. This varies from a PA,NP to a physician. If the examiner feels the person does not have an emergency, he/she is directed to the business office for payment. The person then pays a fee(varies from hospital to hospital but usually around 150.00) if they decide to stay for treatment.
    Does your hospital do this and how does it work?
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  2. 23 Comments

  3. by   Altra
    Very curious ... can you provide more info about how this gone over in the community and/or portrayed in the local media?

    What are the protocols definining "nonemergent"? For example - in the ER where I work we use the 5 level ESI acuity rating ( 1 = unstable/near death and 5 = "really should have stayed home and taken some Tylenol" or very minor procedures like suture removal ... would this program only include the level 5s or also the level 4s? What about the nonemergent/non-monitored level 3s, like that belly pain in someone who isn't keen on sticking around to complete the 3-hr. prep for a CT scan, although the prudent medical decision is that they "should."

    I'm very interested in any and all approaches to educate the public about appropriate use of the ER - if I continue on towards my MSN this will probably be my area of interest in research.

    My facility would never take this particular approach, as serving the poor is part of the mission statement. But I can immediately think of half a dozen frequent flyers who I would *love* to direct down the hall for payment before we hand out those Vicodin.
    Last edit by Altra on Aug 21, '06
  4. by   CaseManager1947
    We don't handle it that way, but do try to collect any co-pays after treatment. When I was seen in the ED lately, the did do the triage, I was seen by the NP and MD, given my go-home instructions and rx. and directed to see the lady about my co-pay. Seems reasonable to me, if I can walk in and out, I should be able to write that co-pay check.
  5. by   Altra
    Quote from CaseManager1947
    We don't handle it that way, but do try to collect any co-pays after treatment. Seems reasonable to me, if I can walk in and out, I should be able to write that co-pay check.
    Agree ... and here the registration clerks try to collect co-pays after discharge as well. Mixed results on that ... if the patient has insurance w/a required co-pay, this is indicated on a separate sheet that prints out w/the discharge instructions. Our standard line after going over discharge care instructions, prescriptions, follow up, etc. is " ... so these papers are all for you to take home, but keep this one separate - the clerk at the desk will take that from you on the way out." Many people scan it quickly, notice the co-pay listed, and simply walk right out past the clerk. So they get billed of course, with mixed results also.
  6. by   classicdame
    yes and no. We get the basic information, like name & address plus complaint, tell them payment is due today then allow them in ER. A rep from the business office then gets info at bedside, situation permitting. This increased collections somewhat and patient satisfaction because they get the perception that we want to care for them. However, we mention money on the first contact, so patient's know what to expect.
  7. by   TazziRN
    As a typical overworked RN (see thread re: Rules), I love the idea. I think it's perfect for the people who use the ER as a convenience clinic. However, there are times when that wouldn't be right: when something happens that a parent has never seen before in their child and panics, only to find out it's normal. Or (as often happens in my town) on weekends the clinic is staffed by a PA, and their policy is that the PA does not see babies under 4 months or pregnancy-related complaints (unless it's a routine OB check). Those pts are sent to the ER by the clinic, so they are just doing what they were told. They may be prepared to pay a clinic co-pay of $20-50, but they would not be prepared for an ER co-pay.
  8. by   ern91
    Quote from TazziRN
    As a typical overworked RN (see thread re: Rules), I love the idea. I think it's perfect for the people who use the ER as a convenience clinic. However, there are times when that wouldn't be right: when something happens that a parent has never seen before in their child and panics, only to find out it's normal. Or (as often happens in my town) on weekends the clinic is staffed by a PA, and their policy is that the PA does not see babies under 4 months or pregnancy-related complaints (unless it's a routine OB check). Those pts are sent to the ER by the clinic, so they are just doing what they were told. They may be prepared to pay a clinic co-pay of $20-50, but they would not be prepared for an ER co-pay.
    When the panicky parent arrives with the child who has a non ugent or semi urgent condition, the parent is told it is not an emergency. thus relieving the parents fears, but also allowing them to pay and stay or go to the clinic in the am. This ,of course , is at night. During the day, the person has the option of being seen in our express care area, which operates 11a to 11p.
    They still have to pay because it is not a complaint that needs to be seen in
    an ER.
    We operate with a 5 level triage system and the people this pertains to are
    classified as non or semi urgent. All of those classified as urgent are seen the main ER and not asked for payment up front. They are asked for their insurance copays or partial payment as the situation allows.
    Many doctor's offices send their pts to the ER during the daytime which I find a huge part of the problem contributing to the already broken health care system. I have also found, after 15 yrs inthe ER, that doctors send their Medicare patients to the ER quite regularly and the complaints are usually not an emergency.
    As this has been a practice in my community for awhile, I can't comment on the initial reaction of the public. I worked in a county trauma center when this started a couple of years ago, and of course the county hospital did not have this policy.
    I did see a bit on the local news about a mnth ago reporting that the county hospital was finally going to implement this. Haven't heard how its going, but I'll bet they had to beef up security!!
  9. by   TazziRN
    I'm sorry, I didn't make myself clear. I mean being PREPARED to pay....checkbook, cash, whatever. I've seen panicked parents forget the diaper bag, only to find out that what they thought was a seizure was a huge hiccup.
  10. by   ern91
    Quote from TazziRN
    I'm sorry, I didn't make myself clear. I mean being PREPARED to pay....checkbook, cash, whatever. I've seen panicked parents forget the diaper bag, only to find out that what they thought was a seizure was a huge hiccup.
    Well, if it was just a huge hiccup, they wouldn't have to pay. The doc (or other qualified person ) would so the screening, tell them it was a hiccup and then they could go home. No payment for the triage or the screening. This is provided it was triaged as non urgent. Now if the triage nurse makes this pt urgent, the doc can downgrade if need be.
    Then we go back to square one and the pt doesn't pay.
  11. by   TazziRN
    Quote from ern91
    Well, if it was just a huge hiccup, they wouldn't have to pay. The doc (or other qualified person ) would so the screening, tell them it was a hiccup and then they could go home. No payment for the triage or the screening. This is provided it was triaged as non urgent. Now if the triage nurse makes this pt urgent, the doc can downgrade if need be.
    Then we go back to square one and the pt doesn't pay.
    AHH, I see! There is a bill only if it goes beyond the medical screening...that makes sense!!
  12. by   firstaiddave907
    But how does the hosptail determin who would get charged and who wouldnt get charged. would someone get charged if they came in with a smiple cold where if a pacient came in with possible appendicitis they wouldn't get charged?
    Last edit by firstaiddave907 on Aug 21, '06
  13. by   TazziRN
    Quote from firstaiddave907
    But what if there health insurace covers emergency room care then do you chagre it to there health insurance company?
    Not the copay, unless there is secondary insurance.
  14. by   TinyNurse
    I have had an opportunity to work at these EDs as a travel RN, and it is great!

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