estimating patient financial responsibility keystone aaham - february 18, 2010
TRANSCRIPT
Estimating Patient Financial Responsibility Keystone AAHAM - February 18, 2010
Patient Responsibility Estimation
Patient Responsibility Estimator provides accurate, real-time estimates of patient financial responsibility enabling providers to communicate out-of-pocket healthcare costs to patients and set financial expectations prior to services being rendered
Patient Responsibility Estimation
• Consumer-directed and other high-deductible health plans today share costs with members/patients
• Patients are waiving health benefits due to rising premiums• Patients are responsible for greater percentages of healthcare costs in the
form of higher deductibles, co-pays and other out-of-pocket expenses.• Increased patient financial responsibility contributes to a dramatic rise in
uncollectable bad debt for providers. • Price transparency in healthcare and the capability to collect payment prior
to services being rendered enables providers to protect their revenue cycle and helps patients make better informed decisions about healthcare treatment and costs.
Facility Discovery
• Are you currently taking payments upfront?
– Identify current locations payments are received
– Is there a cashier within these locations or will this position need to be added?
– Is there a Patient Financial Representative available to the staff if needed?
• Currently giving estimates?• Who handles contracts today?• Do you know the “shoppers” calling today?
Facility Considerations
• How does registration know which procedures/tests patient present for?– Is it by location of appointment in HIS?
– Is this by order only?
– Decentralized scheduling?
– Do they have access to charge master data??
– Do they have access to coding data?
Facility Locations
• Pre-Registration
– Which departments are pre-registered?
° Review if Lab/Radiology are included
° Review elective procedures
° Review planned surgical procedures• What limited information is needed to consider a patient pre-
registered?
Eligibility and Estimates
• Review eligibility verification process and payers• Incorporate real-time verification with estimates• Patient hand outs
Charge Master Review
• Specific locations to include/exclude• Off site facilities, different charge codes/masters• What are top 25 Electives?• Are there services that are bundled/grouped?• Different charge codes for payers?• Allowed and contract amounts
Measure Success (KPIs)
• Co-pays and deductibles collected prior to service today• Amount collected today• Charity Care• Discounts• FTEs• Denials – Non-covered services are a leading cause of denials• Refunds• Communicate results to staff• Continue to measure
Lack of Patient Education
•Patients often do not understand their coverage• Many patients do not understand or are afraid to ask about the procedure their physician ordered•According to the Q3 2007 HARA Report, 95% of hospitals don’t believe that their patients understand their bills•Patients that do not understand their services/bills, are likely not pay their bills!
Patient Training
• Patients are not used to hospitals asking!• Start asking – your dentist does• Create campaign to educate patients that you will be
asking• Post flyers within your facility• Provide handout to give to the patient• Keep asking!
Review• Patient
– Education– Estimate the financial responsibility for the patient’s at or before the
point of care• Calculation Estimate
– Benefit/Eligibility for patient– Facility contracted/allowed amount for the patient’s health plan
• Documentation– Available print out for the patient applying the calculation of:
° Co Pays° Deductibles° Co Insurances
Benefits
• For the patient– Improved satisfaction
° Price Transparency° No surprises with cost
• Calculation Estimates– More meaningful to the patient– More accurate than billed charges
• Documentation– Providers have the ability to collect more upfront for co-pays,
deductibles and co insurances– Providers can reserve the amounts on the patient’s HSA account or
establish a payment plan if necessary
So Why PRE?
• It is estimated in 2009 the uninsured will spent <$40 Billion out of pocket
• 25 million Americans can't afford to cover the gap between what their insurance covers and their medical bills CNN Money
• About 20 percent of hospitals still had negative total margins in the second quarter 2009 Reuters
• Collection % decreases 40 % after service
• Database storage for full recall
• Patient Satisfaction
• Turn all POS locations into cashier and PRE experts
Questions
Thank you!!
