Offer patients fast and accurate estimates
Move is toward pricing transparency
If patient access employees can’t quickly give patients accurate information about their out-of-pocket responsibility, this problem can directly threaten the hospital’s bottom line.
"Correct estimations could certainly increase patient satisfaction and loyalty. The converse is true, if estimates are inaccurate or not provided," says John Woerly, RHIA, CHAM, FHAM, senior principal at Accenture Health Practice in Indianapolis, IN.
However, less than 30% of patient access areas use patient liability estimation software, estimates Woerly. Continued growing numbers of underinsured and self-pay patients make this even more important for patient access to do well, he adds. "Accurate, patient-friendly estimates are essential to make patients aware of their financial responsibility before services are performed," says Woerly. "Pricing transparency is an expectation of healthcare reform. It is increasingly expected by healthcare consumers."
The information used to collect payments upfront and to establish payment plans must be accurate, he emphasizes. "Patient estimation tools provide confidence to the user that they are providing an accurate estimate to the patient, and patients perceive clarity in knowing their financial responsibility," Woerly says. The tool can assist in determining "propensity to pay" and segment patients who might qualify for charity care or other funding resources.
Without this automation, patient access employees must request a deposit or rely simply on information gathered at the time of insurance verification. As a result, they might not collect the full and correct amount, nor screen the patient appropriately for financial assistance.
"The correct estimation will minimize potential refunds resulting from inaccurate cost estimates and ensure compliance with charity care and uninsured policies to protect against litigation," says Woerly.
The Affordable Care Act (ACA) has resulted in pressure to drive reimbursement down, increase the complexity of the reimbursement process, and increase the size of the patient’s copay, coinsurance, and deductible amount, says Dan Schulte, executive vice president of revenue cycle solutions for The Outsource Group, St. Louis, MO.
"The need for software to professionally and aggressively manage this aspect of reimbursement becomes very important," says Schulte.
However, less than 20% of The Outsource Group’s customers use any kind of patient price estimator software. Schulte says to take these steps to maximize the benefits of patient estimator tools:
• Decide which tool will work best with your patient accounting or patient management system.
• Incorporate scoring and ability to pay functions.
It is not enough that patient access gives patients an accurate amount in the presentment letter, says Schulte: You also should be aware of the patient/guarantor resources to help the patient plan an appropriate payment strategy.
"The spirit’ of the ACA and IRS 501(r) suggest that the provider understand the patient’s financial situation before pressing for payment," Schulte adds.
• Incorporate a presumptive charity care screen.
"Prevent any customer service damage done by making demand on a patient who is indigent but not qualified for other safety net services, or who owes a share of cost, copay, or deductible and has no disposable income," advises Schulte.
• Develop good financial policies for pre-registration and patient advocacy.
It’s important that patient access processes help patients with financial counseling, determine propensity and ability to pay, include electronic and online payment options, and reasonable payment arrangements, says Schulte.
"I don’t see how a professional revenue cycle management team can do its job without a tool that manages the patient balance estimation process, even at a kiosk level," says Schulte.
• Dan Schulte, The Outsource Group, St. Louis, MO. Phone: (314) 692-6500. Fax: (314) 567-5246. E-mail: email@example.com.
• John Woerly, RHIA, CHAM, FHAM, Senior Principal, Accenture Health Practice, Indianapolis, IN. Email: firstname.lastname@example.org.