Overcrowding in Emergency Rooms
Published April 25, 2012 | 
Overcrowding in Emergency Rooms is not really an indication of facilities making more money. Generally, people are coming to the ER because they do not have insurance and/or cannot afford regular healthcare at a doctors office or Urgent Care Center. Most people know that they are supposed to be able to walk into any Emergency Room in the country and be able to receive medical service without having to pay for it upfront. In some cases that is not true. Such as when they are discharged the patients should be asked to pay their ER Copay, a deposit on self-pays or make some kind of payment arrangements for the same. Eventually the patients will receive a bill for services if their insurance company does not pay for the whole bill and if the patient didn’t pay their portion before they left the facility. Some patients will actually contact the billing office to make payment arrangements or fill out a charity form, if they qualify, and that helps with the bottom line. However, a vast majority of self pay patients simply ignore their bills. What can be done to reduce this trend? We, as Emergency Room Registrar’s, Patient Account Reps or whatever you are called, can do about this? Nothing really. It is up to your managers and administrators to decide how or if they are going to curb this trend in their area. Because of the Federal EMTALA rules we are required to give a “Medical Assessment” of anyone who comes in or is brought in for a medical emergency. There is a debate as to what, exactly, constitutes a Medical Assessment. Some feel that only an emergency room doctor can assess a medical emergency. Since, the ER Doctor is usually not the first person the patient sees then the patient will be waiting their turn a while, depending on the diagnosis or symptoms, before they get that far and we can actually do our jobs. What can be done to reduce the wait-time and weed out true medical emergencies from those that can wait?
There are several strategies out there that are receiving some widespread approval and may cost a little more in the beginning but are actually helping the overcrowding of the ER, reducing bad debt to the hospital and increasing collections from patients up-front. Thus, making our jobs a little bit easier. One of them is having a “Qualified Medical Person” in the lobby area assessing patients as they come in to determine if they have a “True Medical Emergency” and should be seen as quickly as possible or are what is considered low priority and can be required to register and pay for their services prior to receiving them. EMTALA only really guarantees that they will be assess and if necessary, to prevent loss of life, limbs or serious bodily damage to be treated as quickly as possible. In other words if you go into an emergency room with a cough, cold, scraps, toothaches, or non-specific abdominal pain then you will have to make payment arrangements prior to seeing the doctor for a prescription and any expensive tests.
Should everyone have access to decent medical care? Absolutely! However, should you go to an expensive Emergency Room just because you have a cough, cold, scrap or bruise. No! Emergency Rooms are for those people who are having a true medical emergency and cannot wait for the doctor’s office to open up. What can you do if you don’t have medical insurance or the wherewithal to pay for medical services? Check the yellow pages for services available in your area. If there are none then check with your local government and see what they are doing about it. Get together with your friends and relatives and start a petition to have the county you live in to create a “Free Clinic” that is opened nights and weekends. If you know any medical personnel such as doctors, nurses, medical lab techs, etc ask them if they can volunteer a few hours a week to help out. Contact local businesses and ask them to donate a small portion each month or once a quarter to help fund the supplies and equipment needed. You can even contact all the local hospitals and ask them to help with supplies, money and personnel. Hey, it is in their best interests to have a FREE clinic to help reduce their bad debt, reduce overcrowding and even get some good press in the bargain! Your community has to pull together if you want solve this problem.
What is that Smell
Published May 27, 2011 | Here is a subject that is not really discussed and that is smells that you have to deal with at work. Being in a medical office setting we have to deal with a variety of things and keep our composure. Most of us have to deal with sick patients and they may have their own kinds of smells depending on the sickness. And we have to be careful of what perfume, powders and lotions we use because what we wear can affect our patients and our co-workers. Sick patients have compromised immune systems and perfumes, lotions and powders will make them feel worse and unable to breath sometimes. In an enclosed office your co-workers can be affected as well. The best practice is to not wear anything at all. Always go to work with just the smell of your soap.
There are a variety of different articles on the web discussing this very subject. Most are studies about how perfume adversely affect asthma patients but most of them discuss the chemicals in perfumes and lotions that people are not aware of that can affect their health as well as their patients.
http://www.livestrong.com/article/228365-perfume-health-risks/
And here is a video from a doctor about his office policy of his patients and staff not wearing perfumes and why:
What Online Tools Do You Use
Published April 13, 2011 | What Online Tools Do You Use for your patient registrations? Utilizing whatever tools you can to ensure that you get accurate and timely information on ALL of your registrations is important for you keeping your job as well as making sure that your company stays in business. With the advent of the Red Flag Laws we are required to ensure that our patients are who they say they are. There is also the the ever increasing problem of patients seeking medical care just to get prescriptions for drugs who will tell you wrong information. This is especially true in Emergency Rooms across the country and with the EMTALA ruling we are required to treat patients regardless of their ability to pay. I am not advocating turning patients away or making them wait a long time for service but you should treat each registration of the patient as a new patient and confirm everything when they come in as well as ask for positive ID and their insurance cards. You cannot get a 100% accuracy rate but you can come close.
To that end we use a variety of online tools to ensure that the information we get from patients is current and accurate. To verify a drivers license you can try online verifications offered through your state’s DMV. To verify addresses you should try the postal service www.usps.com by putting in the address but not the zip code. They will tell you if the address is valid and deliverable. You should also try a reverse directory website for checking phone numbers and addresses. One of these that does not charge is www.whitepages.com. And you can use your county’s property appraiser’s website to verify an address and the owner.
Lastly, you should considered purchasing and using on online insurance verifications website such as Passport and Emdeon. Passport has the ability to verify social security numbers and have a wide variety of payers as well. They also have a payer address and claims information database that is fairly decent. WebMD or Emdeon is a very nice service as well. Now these are pay-for-use services and you will have to negotiate your own rates with them. You can also take advantage of the free services offered by each of the major insurance carriers. Availity is offered by our Medicare intermediary for free to Medicare and Blue Cross providers. Of Course, Tricare has an online eligibility verification system that is free to providers. United Healthcare offers their providers with online verification as well as the ability to view their insurance cards should a patient forget to bring one with them.
These are just some of the many tools available for Patient Access Reps or Insurance Clerks (whatever term your employers uses for Registrars) that can be used to help you do your jobs effectively and efficiently. It will also help your billing and collections department do their job in a timely manner. The name of the game is to ensure accuracy of information, entering information into your computer system correctly and make sure that the claims go to the right insurance as quickly as possible to get the money back.
Telemedicine
Published March 16, 2011 | Do you know what telemedicine is? It sounds like patients are receiving medical care through their televisions. That is not too far off. There is a growing trend of medical professionals consulting on patient care through the use of video conferencing. We have seen a stand alone device much like a robot with a high resolution video camera that can transmit real-time images of patients to doctors from anywhere in the world. Now you are wondering what this has to do with any registrar or patient access person? Well, the answer to that is really simple, no matter what fantastic technology medical researchers come up the patient still needs to be charged for that service and as a Registration person we have to make sure that the patient’s demographic and insurance information is gotten from the referring facility and keyed into our billing system.
Generally, the patient is not seen or available prior to this type of service but we are still tasked with ensuring the information received from the referring facility or doctor is accurate. Every facility has their own version of a “Facesheet” with patient information and their own policies about transmitting patient information via fax or email. So, before your medical personnel agree to this service we would hope that there is an agreement as to the minimum amount of information that must be available to satisfy your own billing requirements. We would assume that includes the patient’s name, address, telephone number, date of birth, social security number, sex, race, religious preference, employer, next of kin contact info as well as complete billing information. A copy of the patient’s identification and front-and-back copies of the insurance cards would be a plus. Each of these data points should be gotten just in case that patient ends of being transferred to your own facility. Remember you will need to verify as much of this information as you can using your online tools.