Within the healthcare system, emergency departments have the highest rates of uncompensated care for underinsured and uninsured patients. As the hardest place to confirm insurance coverage, and where costs to both hospital and patient are the highest, it’s no coincidence that bad debt is most prevalent here.
Emergency department visits reached a 10-year high for all age groups in 2015.1
Under EMTALA, hospitals are obligated to treat patients regardless of their ability to pay for care. By law, questions about insurance and payment cannot be asked until a patient is stabilized.
Hospitals want to minimize uncompensated care, but it’s a challenge in their emergency departments. The good news is there are revenue cycle strategies that can be put into place to help optimize payment efforts in the emergency department, including:
Educate the patient on when an emergency room visit is necessary
The increase in emergency department visits has become a level-of-care problem. Patients avoid going to the doctor because of cost — due to higher deductible plans or being uninsured or underinsured. However, regular visits to a primary care physician can help identify and monitor conditions before they become severe and warrant an ED visit. Other strategies include providing a comparison grid to patients to show the costs in each setting, ranging from primary care ($), to urgent care ($$), to ED ($$$) to inpatient care ($$$$).
Utilize advanced tools to run demographic information against payer information
Being able to cross-reference demographic information can be enough to find potential insurance coverage at check-in. This method can be especially useful when patients don’t know whether they have insurance coverage. It can also aid in identifying coverage of patients who choose not to disclose their insurance information.
Offer a checkout area in your ED
Having a checkout area provides a final touch point to potentially identify necessary insurance information and payment for services. It also allows staff to summarize and review the care plan after discharge to hopefully reduce readmission.
Empower staff to have conversations with patients about payments
It’s not always easy to ask patients to pay for services, especially in the emergency room when they may be experiencing an unexpected health crisis. Train your front-end staff on how to appropriately and compassionately bring up the topic of payment. Give patients payment plan options and/or opportunities to receive a discount for advanced payment.