Payment predetermination

By Rene Letourneau | October 4, 2011 | 5:03 PM

Cost estimates increase payment rates and satisfaction

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As the number of self-paying patients and high-deductible health plans grows, providers are encountering more difficulty than ever before with collecting payment for services rendered.

One tool being successfully implemented is payment estimator software, which calculates a patient’s financial responsibility before a procedure is done.

“From our perspective, it’s going to be key as you see more and more self-pay patients come through the door,” said Scott Armstrong, vice president of revenue cycle solutions at Eden Prairie, Minn.-based healthcare consulting firm OptumInsight.

“There’s a greater likelihood of collecting cash up front if you have the ability to give these estimates,” said Armstrong.

The software instantaneously determines the patient’s out-of-pocket expense by calculating their insurance eligibility data, the contractual obligations of their insurer and the historical cost information of the procedure they are scheduling.

“The system allows us to come up with an estimate to present to the patient as early in the process as possible, starting at scheduling,” said Armstrong. “We hope (our clients) see at least a 3-5 percent increase in up front cash collections after six months of using the system.”

Milton Silva-Craig, executive vice president of Chicago-based consulting firm TransUnion, believes the payment estimation software is win-win.

“The benefits are there for both providers and patients. One of patients’ top frustrations is not having greater transparency of what their liability is,” he said.

Based on TransUnion’s Pulse Poll survey results, Silva-Craig said, “Two-thirds of patients would prefer to know prior to service. The reality is that it is incumbent on providers to begin using these tools.”

“The drive towards consumerism is dictating the need to allow patients to shop for services,” added Jim Bohnsack, TransUnion’s vice president.

Armstrong echoed the sentiment. “Patients are becoming price shoppers. They are much more savvy because of self-pay and high-deductibles. There’s a lot of out-of-pocket expense, so you shop around,” he said.

Providers who implement the software are seeing positive results with higher payment rates and increased customer satisfaction.

At INTEGRIS health in Oklahoma City, Okla., Brent Grimes, administrative director of patient account services, and his staff have implemented pricing software, and they have also introduced the toll-free priceline, which averages about 800 calls per month from potential patients seeking estimates.

“We found it helped with the back end functionality. We have an informed patient who is not in shock after receiving the bill because they are expecting to be billed for a certain amount,” Grimes said of the hotline.

“It has definitely helped us,” Grimes added. “We’ve had a nice increase with point of service collections over the past three years. There’s been a reduction in non-payment. It’s had positive outcomes for us.”

INTEGRIS has also found the estimation software useful in determining patients who are eligible for charity care or who may be eligible for Medicare or Medicaid coverage, noted Grimes.

There are some training and culture shift challenges involved with implementing the software, although the ROI outweighs these concerns, said Silva-Craig.

“The biggest challenge is the cultural buy-in from the board all the way down to the frontline service folks, including physicians. It takes time to educate employees and patients,” added Bohnsack.

For more on the revenue cycle, see bit.ly/hfn-rcm.

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Topic:

Revenue Cycle Management

Payment predetermination

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