Collecting co-pays at the ED registration desk.

EMTtoRN · May 29, 2005

I work as a registrar part time in the ED and collection of copays goes like this:

1) We ask upon registration whether or not they would like to pay their copay at that time. We have both a cash box and a credit card machine to process payments.

2)During the hours of 9-5 M-F we have a financial counselar that also follows up on copays.

3) If the copay is not paid they are billed for it.

I think the process works very well.

Our facility is suggesting that we start collecting co-pays on insurances at the ED registration desk upon discharge. I am completely against this... Any feedback out there?
To add clarification here... we do not have a locked ED. We are a small rural ED and this task is one they want to add to my registration/secretarial support staff, of which there is only one 24/7. We do not have a policy where patients go to a discharge desk or window. There are several different people who function in the registration and secretarial role and I have concerns for them.

nursejennie76 · May 30, 2005

At my ER certain patients are flagged in the computer when they come in, I am sure it depends on there insurance. And when they are discharged they go to a financial counselor that has a office in the ER. They are ont required ot pay at that time but they can if they want to or make other arrangements. I think this is a good thing because sometimes bills are overlooked when you get them in the mail and you will remember to pay if you have talked ot someone face to face. Jennifer

ryoung0302 · May 30, 2005

This goes to Dixielee, you are saying it perfect, You dont know how many times I have asked patients that same question. Most of the time they look at me like I am crazy, but then again you have to be to work in most ERs.

To TlhRNed, I understand where you are cmoing from, but you have to understand how much money is lost by people not paying their copays. I have been working in an ED for the 8 years and we have a standing rule that upon discharge the chart is walked either by a nurse or tech to the discharge desk and they are called up there to recieve all their paperwork. This has really increased our copayments, and actually helped us to make budget a couple of times. I am in a big city so most of the time we are used as a doctors office when people cant see their PCP. It has nothing to do with being rude to the patient, but you have to get somemoney somewhere.

Hope you are able to get it all worked out.

needsmore$ · May 30, 2005

We also collect copays at discharge- community hospital- about 38,000 visits/year. Doing this has decreased a lot of lost revenue for our facility! Echoing Dixielee-this is not a nursing function, also- we do bill if needed but we accept credit cards.

I know the ED is for "accidents and ---god forbid- emergencies"; and many may not have money at the time- for MVAs, workers comp injuries there is no copay- that's why we do bill if needed. If people are starting to use the ED as another or instead of the"doctor's office"- then they should expect to start paying for services.

I also believe that private physicians who refer patients to the ED to be seen because of whatever reason ( no appt time available, need additional tests, etc) need to tell these patients that they will be expected to pay the ED copay $$$. I have seen many get upset because they paid their office visit $$$, referred to the ED for the ED doc second opinion and some lab/xrays, get discharged and get hit with usually a higher ED copay!

Happy Memorial Day-be safe all

Anne

candyndel · Jun 1, 2005

Everyone is moving to collecting co-pays at discharge. (We generated $40K last year by doing so.) We also sign patients up for chartity care at that time and verify their demographics.

Its inevitable, so dont fight it (and you as the nurse wont be doing it). Do a lit search and you will see all the articles that have been recently published about it in favor of it.

**canoehead, BSN, RN** · Jun 1, 2005

If you are uncomfortable totaling the charges for that day's care a good solution would be to look into the account and see if there are charges outstanding. Ask them if they would like to make a payment on their outstanding balance. You'll be rewarding those that pay promptly with a quick and easier discharge, and letting your repeat offenders know that what they owe is not forgotten and forgiven as soon as they walk out the door.

NIGHTOWLDV · Jun 25, 2011

I work at a small rural hospital and I work the "night" shift. I do collect co-pays and if they are self pay I will collect 100.00....of course this is all done when patient is discharged. I was yelled at tonight by someones "finance" because he said I violated EMTALA by collecting money from her because going to the ER is free. What is sad...is MOST people think that!!!! I wanted to so bad...say to him...ok so when you go to the grocery store do you go tell them that you thought it was free? Most of these people have no intensions on paying their bills. If patients tell me they cant pay their copay, I will set them up on a payment arrangement. But dont come and yell at me and call me all kinds of naughty words and tell me I am violating EMTALA just because I asked for a copay AFTER you were seen and you gave it willing.

rjflyn, ASN, RN · Jun 26, 2011

Our suburban hospital does this. Surprisingly most our pt complaints come from this process and in fact its considered a separate department. We see a lot of uninsured and private pay patients so its at this time they get offered other options. They get signed up for example it they were assaulted for a state crime victim assistance program that will pay for their tx. There are other issues like if you are injured on a bike and have car insurance that make things tricky. Its in the patients best interest to stop and talk even if they cant pay anything at that time, just to make an arrangement of fill out some paperwork.

marlboroking · Jun 26, 2011

I think it's a good idea. It's a way to collect some money. What does it hurt, if they can't pay, they won't, if they do, it's a bonus.

ErinBSN · Jul 4, 2011

We have a small ED. our Registration collects at BEDSIDE. This way it's a discrete environment and we can work out payment arrangements etc. It seems to be productive.

Is something like that an option? They have computers on wheels with credit card swiper things and they do it all at bedside.

If not, I look at it this way, Co-Pays are what help us run. I pay mine, I expect the patients pay theirs. If they need to work out arrangements, that is as good of time as any.

mwboswell · Jul 5, 2011

Our facility is suggesting that we start collecting co-pays on insurances at the ED registration desk upon discharge. I am completely against this... Any feedback out there?
To add clarification here... we do not have a locked ED. We are a small rural ED and this task is one they want to add to my registration/secretarial support staff, of which there is only one 24/7. We do not have a policy where patients go to a discharge desk or window. There are several different people who function in the registration and secretarial role and I have concerns for them.

If this original poster is still on here now 6 years after the original post - I'm just wondering, how did this work out for you all?

ImThatGuy, BSN, RN · Jul 6, 2011

I'm all for paying before services being provided particularly in a public access facility. In fact, I have opinions that completely go against "everyone must be seen."