Non-Urgent Emergency Patient Payment Responsibilties

[EmergencyLoveRN]

i work for a rural florida proprietary-owned 6-bed emergency department. administration is trying to implement a new triage system that would be cost effective for the hospital in reducing the incidence of self-pay non-emergent patients abusing emergency room services. in other words..."free" medical care, since these patients rarely if ever follow through on a pay schedule and pay for services rendered.

the current system is set up for the patient to get an "emergency medical screening" (ems) as state law dictates. if the patient is deemed non-urgent by the physician, he/she is then sent to the rural health clinic located on the same campus or directed to another facility if they aren't able to make payment. state laws and federal rules and regulations state "if a patient does not have an emergency medical condition they pay for the services to be treated or they are not treated". this system seems to work great during the day when the business office and clinic are open. however, patients have quickly learned that after-hours there are no clerks available to verify insurance coverage and/or request payment. administration is attempting to place this duty to the night nursing staff and threatening disciplinary action including possible termination if non-urgent patients are being treated anyway "regardless of ability to pay".

the owner refuses to pay the extra money necessary to keep a 24/7 clerk on staff. to make matters more challenging, the hospital has not converted to a computerized system allowing for quick, easy access to previous records or patient verification records. medical records are also unavailable after hours. we are at the mercy of what the patient tells us and the identification they may or may not have with them. i don't believe a medical professional should play the role of debt collector.

i would love some advice and or florida law guidelines that i can present to my director to show that nursing staff should not have to take on this dreaded role. what system works for other small hospitals?

[Katnip, RN]

Having nurses do this job sounds like a conflict of interest to me. I'd check around and see if this would even be legal.

I'm with you. I don't think collecting money is within our scope of practice.

[nolabarkeep]

I would refuse to collect the money. You are a RN, not a cashier. We are responsible for doing patient charges and I don't feel like RN's should be responsible for this. I could potentially be sued for fraud if the charges I enter are inaccurate. To make matters worse, the template we are presented with to base the charges is extremely confusing. Look, RN's are jack's of all trades. We are intelligent, inventive creatures that have the ability to do much. And we do MUCH without whining about it. This is why we are so easily taken advantage of. Be careful.

[BabyRN2Be]

Wow, the owner must be pretty cheap. They don't want to be "taken" by those who don't want to pay or present with false ID to avoid paying, yet they don't want to hire one clerk at ~$8/hr (around here anyway). Wow... and people wonder why our healthcare system is so messed up.

[Batman24]

Having nurses do this job sounds like a conflict of interest to me. I'd check around and see if this would even be legal.

I'm with you. I don't think collecting money is within our scope of practice.

Agreed. I would call the BON. Ask them to send something in writing.