Hospital's Pre-registration Efforts Pay Off in Collections

The last thing you want to learn at your hospital, as a patient sits at your registration desk:

• They can't pay, and no one knew prior to service
• Their insurance changed, and authorization is required
• They recently lost their job and have not paid their COBRA benefits.

At this point, you may end up with an unpaid account—and in this economy, that's not good news when hospitals continue to lose reimbursement dollars.

Pre-authorizations are crucial today. It is vital to cover all the key areas and prevent the patient and the hospital from learning bad news. The process covers more than just a pre-registration:

• Insurance verification
• Upfront payment notification to the patient
• Total out-of-pocket payment
• Payment options when full payment cannot be made
• Opportunities to screen for government assistance programs
• Medical Necessity check
• Medicare Secondary Payer check
• Accurate demographic/financial information

Prior to this year, the four hospitals of Baptist Health System Birmingham, AL, struggled with a success rate of "well under 50%," for pre-registration of scheduled patients, says Betty McCulley, CHAM, system access director/consolidated business office at Baptist's headquarters, Princeton Medical Center.

The 1,080-bed system fell behind in many areas because pre-registration staff members often were sent to help register patients during staffing shortages. Pre-registration numbers suffered.

"We were not meeting our pre-registration goals," says McCulley, who manages the patient access managers at the four facilities and serves as the National Association of Healthcare Access Management's Southeast regional delegate. Patients sat with registrars longer because they were not pre-registered. Insurance issues delayed the patient even further.

"And as we all know, 'wait time' is the No. 1 reason patients and their families become so upset," McCulley says. "They are sick, afraid of what they may be facing, and here we are holding them up and asking for information and money. Because the patient had not been contacted prior to arrival they were not prepared to pay upfront."