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If providers fail to keep automated price estimators up-to-date on contract terms and historical claims, incorrect estimates will occur.
"Also, users do not always have the level of sophisticated training necessary to produce the highest integrity on an estimate. These are huge gaps I’ve seen," reports Katherine H. Murphy, CHAM, vice president of revenue cycle consulting in the Oakbrook Terrace, IL, office of Experian/Passport Health, a provider of technology for hospitals and healthcare providers.
In cardiology and radiology, for example, some procedures have associated charges that always go with a procedure, such as a hysterosalpingogram and persantine stress test.
"The estimator must be built to always accommodate these associated charges, because your users will not know to do so," says Murphy. "This leads to misinformation for the healthcare consumer."
To obtain a precise estimate, members of the patient access staff at Strong Memorial Hospital in Rochester, NY, contact the various physician offices to obtain the medical coding information needed.
"This causes a delay in how quickly we can provide the patient with the estimated costs," says Karen Stein, manager of patient services in the hospital’s finance department.
Stein says that software integrating professional and hospital services would be very helpful to the department. When they previously looked at starting this program, no vendor could do physician and hospital pricing in one system.
"That was one of our main requirements. I am not sure if there are any vendors who can now do this at an enterprise level," says Stein. "We are hoping to have this capability directly within our billing systems."
At times, patient access employees give an accurate estimate to a patient, but by the time the service is performed, the pricing has changed.
Murphy says, "Providers must keep in step with all the nuances that affect estimates."
Look for tools that factor in the patient’s deductible or copay, and calculate combination estimates that include professional charges and application of multiple discounts, she says.
"It is even possible for an estimator tool to flag for registration errors which would specifically affect the quality of the estimate calculation," says Murphy.
Estimates that take into consideration the place of service within the health system and the individual physician performing the procedure become even more precise.
"Research all of this thoroughly when automating, to make the best choice to meet your specific goals for transparency, collection, and estimates of the highest integrity," advises Murphy.