Following is Section 1 of the Patient Financial Communications Best Practices. This section addresses communication in the emergency department. See the complete Patient Financial Communications Best Practices.
1. Patient Financial Communications in the Emergency Department
Note: All practices must comply with EMTALA and all other Federal, State and Local regulations affecting the Emergency Department
1.1. Discussion participants: The patient or guarantor will have these discussions with properly trained registration or discharge representative for routine scenarios; financial counselor or supervisor for non-routine / complex scenarios. Patient should be given the opportunity to request a patient advocate, designee or family member to assist them in these discussions.
1.2. Setting for discussions: No patient financial discussions will occur before patient is screened and stabilized. Once a patient has been stabilized, in accordance with EMTALA, the following timings and locations are appropriate for financial discussions.
1.2.1. Emergent Patients: Discussions will occur during the discharge process. The discussion can also occur during the medical encounter as long as patient care is not interfered with and the patient consents to these conversations in order to expedite discharge.
1.2.2. Patients who do not have an emergency medical condition: Following the medical screening, provider representative will have a discussion with the patient during the registration or discharge process. The discussion can also occur during the medical encounter as long as patient care is not interfered with and the patient consents to these discussions in order to expedite discharge.
1.3. Registration, insurance verification, and financial counseling discussions: No patient financial discussions will occur before patient is screened and stabilized, in accordance with EMTALA.
1.3.1. Registration: The provider organization will first gather basic registration information including demographics, insurance coverage, as well as determining the potential need for financial assistance.
1.3.2. Provision of care: Patient will be informed that their ability to pay will not interfere with treatment of any emergency medical conditions. Uninsured patients will be informed the goal of collecting information is to identify paying solutions or financial assistance options that may assist them with their obligations for this visit.
1.3.3. Insurance verification: Once screening has occurred and the patient is stabilized, the provider organization will review insurance eligibility information with the patient to ensure information accuracy.
1.3.4. Financial counseling: If appropriate, patient is referred to a financial counselor and/or offered information regarding the provider’s financial counseling services and assistance policies.
1.4. Patient share and prior balance discussions: These discussions will occur once the provider organization has fulfilled the previous best practice requirements. Interactions will not interfere with patient care, and will focus on patient education. During patient share and prior balance discussions, the provider representative will:
1.4.1. Patient share discussions:
126.96.36.199. Provide a list of the types of service providers that typically participate in the service both verbally and if the patient requests, in writing.
188.8.131.52. Inform patient that actual costs may vary from estimates depending on actual services performed or timing issues with other payments affecting the patient’s deductible.
184.108.40.206. If appropriate, ask the patient if they are interested in receiving information regarding payment options.
220.127.116.11. If appropriate, ask the patient if they are interested in receiving information regarding the provider’s financial assistance programs.
1.4.2. Prior balance discussions:
NOTE: Balance resolution discussion occurs on prior balances that are being pursued for collection by provider, collection agency or other organization. There will be many scenarios where patients will not have prior balances.
18.104.22.168. Discuss with patient the services that led to the prior balance, including the dates of service and the resulting prior balance. Upon the patient’s request, provide the patient a written list of the services provided, dates of service and the resulting prior balance.
22.214.171.124. Ask the patient if they are interested in receiving information regarding payment options.
126.96.36.199. Ask the patient if they are interested in receiving information regarding the provider’s supportive financial assistance programs.
188.8.131.52. Proactively attempt to resolve prior balances through insurance and financial assistance programs.
1.5. Balance resolution: Once the provider organization has fulfilled the best practice steps as outlined above, it is appropriate to inquire about how the patient would like to resolve the balance for the current service and any prior balance the patient may have, as well as informing the patient of the timing of collection activity.
1.6. Summary of care documentation: During the discharge process, the patient will receive, in writing, information regarding the provider’s supportive financial assistance programs, and a summary of the potential financial implications for the services rendered, including a phone number to call with questions.