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This department is usually the first ones to see the patient.  Within this department there may be various areas based on type of admission.  For instance, there is almost always a separate Emergency Room Admission/Registration area as this one must be staffed 24 hours a day, 7 days a week.  The Main Admission/Registration Area is usually located at the main entrance of the hospital and is only staffed during normal business hours.  You may have, depending on the size and structure of your hospital, separate Admission/Registration Areas for Outpatient Clinics or  Outpatient Surgery as well.

 

The functions of each of the departments is the same.  You are required to gather demographic information, make copies of insurance cards, identification cards, claim forms and any other pertinent forms that the patient has in their possession regarding this particular visit.  And collect the required copays or deposits.

 

REGULAR ADMISSIONS - When a patient is admitted to the hospital for a "routine" admission they may be pre-admitted, if your hospital has that function, with a patient account already created, cards copied and in some cases signatures gotten.  If that is the case all you are required to do is activate the patient account, make sure all information on the patient's facesheet is accurate and complete, collect any copays or deposits needed and then direct the patient where they need to go next with the appropriate paperwork.

 

PRE-ADMISSION DEPARTMENTS can be a real time saver for the Main Admitting or other clinic area personnel if they do their job correctly.  Generally, patients are asked to come in a day or two early to start their admission paperwork and get any preliminary tests prior to the actual admission.  During this visit the patient should have all of their insurance cards, identification, preliminary admission orders from the doctors office and be able to sign all the admission/treatment forms.  Depending on your particular state's requirements patients who are being pre-admitted for services are allowed to sign almost all of their paperwork within 72 hours of their actual admission.  If the Pre-Admission personnel are trained properly and have access to online insurance verification they should be able to tell the patient before completing the registration exactly what they need to bring as far as payment on admission day.  Then the Preadmission person must precertify the hospital admission.  Precertification is the key to maximum reimbursement for ALL planned admissions.  If the patient is not precertified prior to admission and is admitted anyway the medical facility may have to write off a penalty amount from the patient's bill or even have the whole thing denied.  Normally, services not precertified or authorized by a contracted insurance is not the responsibility of the patient but the medical facility. The doctors office and hospital personnel must work together to ensure maximum reimbursement for both.

 

Collecting copays prior to the actual admission is usually not advisable as sometimes the surgery has to be cancelled and then you must refund the payment.  Most patients are reluctant to pay ahead of time for services.  One exception you might find is for baby delivery.  Obstetrical admission for actual delivery are almost always preadmitted and the inpatient copays are listed on the patient's insurance card.  Co-insurance amounts for such deliveries is a matter of hospital policy.  You can always plan for a vaginal delivery and repeat C-Sections are almost always planned for ahead of time so it will have to depend on your facilities policy.  Telling the patient of the amount due ahead of time gives them an opportunity to plan.  CONSISTENTLY, applying this policy is the key to better collections.

 

DIRECT ADMITS - Are those that come directly from the doctors office.  There is usually not enough time to preadmit the patients unless they are to arrive after business hours and generally collecting copays for these admissions is problematic.  If your hospital has a good relationship with the referring doctors office they will fax over the patient's facesheet so that the admission personnel will have something to work with prior to the patient's arrival.  If not all information will have to be gotten when the patient arrives.  Once you get the admitting doctor's name, a diagnosis and the required type of bed for the patient the doctor's office personnel should give you the patient's name and date of birth and hopefully, a social security number and insurance information over the phone.  With that basic information the admission personnel can begin created a patient encounter prior to their arrival.   Online Verification with Contracted Insurance is a life-and-time saver as it gives the admission personnel instant access to the patient's insurance contract including when they became effective, if they still are, amount of deductibles still outstanding, coinsurance amounts and benefits for basic tests and procedures.  With this information you will be able to give the patient an estimate of the amounts due. 

 

REMEMBER, whoever does the follow-up on Direct Admits must Pre-Certify the admission within 24 hours.  That means that someone from the admissions department must call the insurance company medical certification deparment with at least the following information:  Patient's Name, Date of Admission, Attending Doctor and Preliminary Diagnosis.  Depending on the Insurance Company's requirements you may get a precert number right then with a RN to follow-up with the doctor's office or hospital personnel within a certain time frame or they will pend the certification for MEDICAL REVIEW!  Basically, someone from their company, generally a nurse will come by and review the medical chart and/or speak to doctor's office and/or Case Manager of the hospital.  THIS CERTIFICATION NUMBER must be present on the billing form to ensure timely payment!

 

EMERGENCY ROOM ADMISSIONS/REGISTRATIONS - These are probably one of the hardest registrations to do.  There are a number of factors that will affect the ability of the registrar from getting the required information from the patients including EMTALA.  EMTALA is the Emergency Medical Treatment and Labor Act that governs how medical personnel in all the Emergency Rooms in the United States are to treat patients.  For the registration department that means that we are not allowed to ask for insurance information until the patient has been "Assessed"!  Since we are not medical personnel and cannot determined when that happens we have to rely on the doctor and nurses to tell us when we can speak to the patient.  The job requirements are the same in that you must get updated demographic and insurance information from the patients each time they come in and it is always best to ask for insurance cards and identification everytime to ensure that your information has been keyed correctly, you know right away if a copay will need to be collected on discharge and you can prove that the patient your treating is the patient on record. 

 

Each facility has its own policy regarding fraud as far as patients receiving treatment goes.  By that I mean that sometimes you will get a patient who gives you false information to get drugs or treatment without having to pay.  With EMTALA we are required to treat any patient who presents for treatment and a medical emergency exists.  The doctor determines the medical emergency part and decides what, if any, treatment the patient will receive.  All we can do is try to get as much data and copies of ID where we can.  Depending on your local laws you may have to call the police to report the fraud and they require at least the minimum information in order to file charges.  So, for these patients you will want to verify the social security number they give to see that it matches their name.  You can do this through a variety of different services.  Some Emergency Rooms even have access to an ID scanner that reads the bar code on the back of an ID and confirms the current address and picture of the patient.  These services cost money and are well worth it to try and reduce the bad-debt for your medical facility.

 

Finally, make sure that you get ALL the information required for the registration even if the data will not pertain to that particular visit.  Yes, we are required to ask if the patient has "Advance Directives"  so if or when the patient gets admitted to the hospital the nursing staff , doctors, and case manager will know to look for them in the medical record.  Yes, we are required to ask if the patient has a "Religious" preference because, again, if the patient ever gets admitted then the nursing staff will know if the patient has special requirements based on religious preference.  And, YES, we are required to get complete employment information including what their title is and main phone number at work.  There are three reasons for this last one:  first, if the patient comes in for a Workers Compensation Accident then we will already have the information in the computer as to who to follow-up with.  Second, some health department data is based on occupation and can later be used for medical studies.  And third, if you should have to follow-up with the place of employment for insurance benefits it would be convenient to know the patient's title at work to verify that you have the right "Mr. Jones at Walmarts".