April 6, 2005
Placing patient service representatives in the emergency department check-out area and providing them with a script to guide them through the payment discussion with patients helps ensure that patients understand your hospital's financial policies and that appropriate financial arrangements are made. Scripts also help staff deliver key financial information consistently for all patients.
The March 2005 issue of HFMA's Revenue Cycle Strategist newsletter provided readers with a sample script, courtesy of Sandra Wolfskill, FHFMA, president, Wolfskill & Associates, Inc., Chardon, Ohio. It detailed what patient service representatives should say to patients who are checking out of the hospital emergency department.
Sample Script for ED Patient Service Representatives
Patient/guarantor arrives in emergency department check-out area:
Patient Service Representative: Good morning/afternoon (applicable title and name). Thank you (name of care professional if patient was escorted). My name is _______, and I am a patient service representative here at (name of hospital). I'm sorry an emergency brought you here today, and I hope things are better now.
Let me explain quickly what we will be doing. Is that OK?
If patient answers no:
Patient Service Representative: What may I help with before we go on?
Based on the response, it may be necessary to reconnect with the care professional or allow the patient some time to take care of some immediate need, e.g., go to the restroom, get a beverage, hand off a child.
If patient answers yes:
Patient Service Representative: I just need to review some of the information you have provided. We want to be sure we have complete and accurate information to file a claim with your insurance company. Let's go over this quickly, and please feel free to interrupt me if you don't understand something or if we have recorded something incorrectly. Does all of that sound OK to you?
1. If patient is insured, patient service representative reviews guarantor information and insurance information.
Patient Service Representative: Great. Then let's move on. We will file an insurance claim with your insurance plan within the next 72 hours, and they should process and pay your claim within 30 days. You will receive a statement from us if your insurance company delays payment; thus, you will be aware of our progress with your insurance company. If there is an excessive delay, you may trust that we will contact you to assist us in getting your claim resolved to your satisfaction.
Your insurance has a $____ copayment for emergency department services. Will you be paying by check, cash, or credit card today?
1a. If patient wishes to pay at this time:
Patient Service Representative: Thank you. I will prepare your receipt.
There is an exchange of the payment and the receipt.
Patient Service Representative: Thank you again, and if you have any questions, please feel free to contact our billing department at (phone number). They will be happy to assist you.
Always close with:
Is there anything else I may help you with at this time?
1b. If patient does not wish to pay at this time:
Patient Service Representative: I understand. In that case, let's discuss what payment options are available to you.
At this point, the patient service representative refers to the financial assistance policy and offers the following options in this order:
Patient Service Representative: I can offer payment in full within the next 30 days?
If the patient responds with a request for a payment plan, offer the payment plan based on the sliding scale rates.
If the patient expresses a financial hardship, the patient service representative offers the following options in the following order:
A. I can review the state assistance program (HCAP) qualification guidelines with you as our first option.
B. I can refer you to our Medicaid eligibility firm to see if you may qualify for Medicaid assistance.
C. I can give you our financial assistance (charity) application, explain the requirements, and give you an envelope to mail it back to us after you complete it.
Always close with:
Is there anything else I may help you with at this time?
2. If the patient is not insured, the patient service representative estimates charges and requests payment in full by check, cash, or credit card. If the charge estimate is questionable, the patient service representative requests $100 payment by check, cash, or credit card.
Patient Service Representative: Great. Then let's move on. Since there is no insurance coverage, I have estimated the charges for this visit to be $_____ (or $100 minimum; if this option is used, explain that an itemized bill will be sent within 72 hours for the balance due). Will you be paying by check, cash, or credit card?
Patient: I will pay by _____ (check, cash, or credit card).
Patient Service Representative: Thank you. I will prepare your receipt.
There is an exchange of the payment and the receipt.
Patient Service Representative: Thank you again, and if you have any questions, please feel free to contact our billing department at (phone number). They will be happy to assist you.
Always close with:
Is there anything else I may help you with at this time?
SOURCE:
"Scripting Patient Financial Communications in the ED" from HFMA's March 2005 Revenue Cycle Strategist newsletter
Additional Resources
- Revenue Cycle: Comprehensive Listing of HFMA Products and Services
- Uninsured Patients: Comprehensive Listing of HFMA Products and Services
If you have questions or comments about HFMA Wants You to Know, contact editor Laura Noble.
HFMA Wants You to Know ISSN: 1540-0697. Volume IV, Issue 7. Copyright 2005, Healthcare Financial Management Association. All rights reserved.