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Hospital aims to collect more patient payments upfront

This article first appeared in the St. Louis Beacon, Aug. 17, 2011 - During a typical stay in a hospital, patients aren't usually required to pay their share of the costs before treatment because the hospital isn't always sure what the patients' portion of the bill will be. But at least one area hospital is fine-tuning its billing system with the expectation that patients will pay upfront in the same way that some people are expected to pay before being treated in a doctor's office.

The hospital is St. John's Mercy Medical Center, which will be renamed Mercy Hospital in St. Louis on Sept. 1. An official says the hospital is investing in a system to give St. John's the "ability to determine a patient's liability for hospital services" and collect that share upfront. It's unclear how many other area hospital systems have or will refine their billing practices in a similar manner.

Sheri Beekman, vice president of revenue cycle at St. John's, notes that co-payments for doctors' services and ER visits are listed on the back of a patient's health insurance card.

But she says, "For hospital services we haven't easily had access to all of the information necessary to accurately determine what the patient portion is prior to services being performed."

The goal now, she says, is to tell patients about their portion and collect it at the time their service is scheduled or before the service is performed.

By collecting patients' portion upfront, Beekman says St. John's would reduce costs associated with mailing bills as well as avoid costs associated with collectors and bad debts.

She says the new approach will mean providing patients with "information they have not had about what they will owe" and would allow "for a conversation." Patients will then learn how they can deal with the bill if they are unable to pay in full, Beckman says.

The aim, she says, is to work with patients facing financial hardship and help them to qualify more quickly for Medicaid, other governmental assistance or charity care.

If some patients are accustomed to being billed and paying later for health services, particularly in a doctor's office, their experience may be an exception to the trend. Many providers are posting notices, explaining that payments for the patients' share of the bill is expected at the time of service unless other arrangements have been made. The notices are a sign of the times, the results of a combination of pressure from insurers and concerns among doctors about what slow payments are doing to the bottom line.

Liz Webb, executive assistant at the St. Louis Metropolitan Medical Society, was asked about co-payment policies among the organization's members.

"I've been told that co-pays basically are governed by your insurance carrier. They are the ones who tell the doctor what it's going to be."

She says the policy might differ from one provider to another. But, on a personal level, Webb says she is "kind of surprised" to hear that some patients are accustomed to getting a bill in the mail. She says her own insurer has always required her to make the co-payment at the point of service.

Mirroring that experience are signs like the one in a specialist's office at BJC's Center for Advanced Medicine at Forest Park and Euclid avenues. The sign says, "We are required by insurance carriers to collect your co-pay at the time of your office visit. Thank you."

But area health providers stress that no patients are turned away if they lack money to cover their share of the fee.

"Our policy is to ask the patient for the co-pay up front," says Suzy Farren, a spokeswoman for SSM Health Care. "That's because the probability of collecting the patient portion decreases dramatically if it's not collected up front."

In any case, she says that patients "are still treated, and we inform them they will be billed. If the patient requests financial assistance, we provide them with a financial assistance form."

She says financial counselors also are available "to help patients better understand their financial responsibility and other payment options. We care for everyone who comes to us for care, regardless of their ability to pay."

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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