So much in the last two years has had us at Outreach Services focusing on solutions for better financial management in hospitals’ emergency departments. This is a great loss area, in terms of percentages for a point-of-service, because patients are rapidly served, medically. That has been a Community Relations boon for a lot of hospitals: how quickly patients are treated in their E.D.

In terms of financial management, however, processes were not as quick to develop…and patients were seen, treated and discharged so fast, hospital administrative staff was not able to conduct the necessary registration processes. Often they are lucky to get good demographic data, much less coordinate and verify insurance, or collect co-payments, deductibles and other payments.

That is where we came into the picture, a few years back. We worked with our clients and established financial triage centers in hospitals’ emergency departments, with a sole focus to mitigate revenue loss caused by data-loss. The process requires collaboration with the clinical staff (who are obliged to quickly transition patients) with an attention to EMTALA. For patients who are not admitted, there is a brief, almost non-existent window of time between treatment and walking out the door. For the most part, this is caused by clinicians’ commitment to patient satisfaction, an honorable motive for sure. Of course there is also the disdain many clinicians have with participating in patient collections. What we focus on in the E.D. is clinician education: explaining that financial triage is important to the patient and the facility, and it is usually very brief. HFMA has much information relating to up-front collections in the E.D. Here is one piece of media: http://www.iplaybackhfma.com/product/61/34.

When relating revenue loss in the E.D. to revenue capture in the E.D. it is obvious that the department has tremendous needs for improvement…what I have been thinking about a lot recently, however is relating revenue loss in the E.D. to hospitals’ total losses in revenue, in regards to missed opportunities. Here is my brief conclusion…it could take ten to twenty losses in the E.D. to equal the revenue lost by one inpatient account. (I consider non-covered/non-necessary services rendered as revenue lost, here).

We have been working with two hospital clients of ours to diagram and implement financial triage centers in their organizations, for non-E.D. registrations. Basically, designing a center like what is installed in the E.D. that will allow us to coordinate and categorize registrations in order to ensure revenue is not lost due to:

• Non-Covered Services (i.e. gastric bypass surgery coded as self-pay, and requiring deposits)
• Lack of Pre-Arrangement of Payments (i.e. ruling out financial assistance and securing payment plans or collections)
• Medicare ABNs
• Lack of Pre-Qualification for Medical Assistance and Charity
• Etc.

In the condition of non-emergent presentation, so much is to be gained by being proactive.

It is understood, that one wrinkle here is working with referring physicians. That is a dilemma that needs to be faced with preparedness. What if a patient does not meet the facility’s conditions for treatment, based on the financial triage screening? Will the hospital still accept and treat the patient in order to satisfy the referring doctor? Well, let me say this, the hospital’s effort will most likely improve the doctor’s own chances for reimbursement, considering most often it won’t be a matter of “yes we will treat the patient,” or “no, we won’t treat the patient.” Rather it will be a matter of when: “We need to work with the patient to apply for Medicaid, we expect this to take a few weeks. After reviewing the registration information and interviewing the patient we feel there is a basis for eligibility.” Or, “After reviewing the registration information and interviewing the patient, the service is not covered by his insurance. We are working with the patient determine eligibility for financial assistance or to make payment arrangements.”

In our business there have been enough times where we were referred an account with six figure charges, only to tell our client that there is no option for them for reimbursement from a payer. For example, we work with a Washington hospital that has surgeons who bring their patients with them from Oregon. In one case, we were referred a patient who had already been treated, and the bill was in the hundreds of thousands, but since the patient was from Oregon, the Oregon Health Plan would not cover the service done in Washington. We recommended in the future, as a stop-loss, that the hospital screen for these scenarios, and instead have the surgeons take their Oregon patients to Portland to receive treatment, when the service is ‘non-covered’ in Washington.

A screening center would accomplish this task, without risk of referring reimbursable services to another facility. In the situation above, all three parties (patient, surgeon and hospital) are better off by going to Portland for surgery.

The point is to use intelligent, predictive systems to best initiate the revenue cycle, rather than dealing with issues after the fact, when very often it is too late.