No one likes unpleasant surprises.
Receiving a large unexpected medical bill often is more upsetting to patients than the actual medical problem that preceded it. Getting hit with a big bill for which they are unprepared makes it challenging for people to pay and for your healthcare system to collect needed revenue. To make matters worse, unexpected medical bills often become unrecoverable debt.
This increasing occurrence of unexpected—and often painfully high—medical bills, combined with the lack of transparency in the cost of healthcare services inspired the Department of Health and Human Services (HHS) to create a price transparency ruling, effective January 1, 2021.
As it stands today, consumers can’t easily compare prices of medical services, so there’s no way competition can be in play to naturally lower prices like in other industries (travel, lodging, retail, groceries, etc.). By providing consumers with a realistic view of potential medical cost, prior to their encounter – HHS hopes to create a more competitive economy, where market forces can help bring healthcare costs down.
Plus, giving patients the information and the time to prepare for large medical bills means they can plan how to pay, such as withdrawing investment funds or enrolling in a payment plan. No matter how they meet the obligation, having a realistic expectation about upcoming medical costs in advance increases the likelihood that you will receive payment.
Some revenue managers have lost faith in estimation software because, in some cases, it failed to deliver realistic estimates. If you’re among them, please keep reading. Thanks to data science, estimation technology is evolving into a reliable multi-faceted solution that improves revenue cycle management.
Estimates based on analytic research can be scored to let you—and your patients—know how much confidence to have in the estimation. This pursuit of a more accurate estimate, one that more effectively sets expectations for the patient, will provide them with increased confidence to make an early payment. An estimate that includes large variability receives a lower confidence “red” score. If the application is highly confident that an estimate is spot on, a high “green” score will tell you so. It’s all about creating the right financial conversation, backed by complete information from a true estimate.
Here are some best practices to keep in mind as you evaluate and invest in estimation software. Specifically, look for:
- An estimation solution that scores estimates (red, yellow, green) for confidence so that the financial conversation and early payment plans can reflect your confidence in the estimate.
- Estimation technology that is tracked for accuracy, so it can continue to improve over time.
- A solution that reconciles the pre-service estimate with the final statement.
- Connects patients with the right payment tools to fulfill their financial responsibility.
Estimating healthcare expenses is just part of superior estimation technology today.
Patient clarity is the goal. So, look for a solution that bridges the gap from pre-service to post-service with accurate estimates and consistent statements, clearly showing any per-service payments. Ideally, it should integrate with your existing systems and registrar workflow, making it easy for patients to pay with payment options from before a medical encounter to the very last payment.
How patients receive estimates is vitally important too.
Estimates should be provided with carefully prepared scripts based on the amount of the estimate and the estimate confidence score. And providers should provide payment options before the medical appointment or healthcare event (at the same time the estimate is provided) to help manage “sticker shock.” It’s all about making it easier for patients to pay, such as including co-pay amounts in appointment reminders with a digital opportunity to pay from the reminder.
Superior estimation and payment solutions that truly prepare patients for what they owe with clarity, consistency, convenience and compassion empower them to meet their financial obligations and increase your organization’s fiscal health.