“Health Care PRICE Transparency Act” Proposed

Health Care PRICE Transparency ActA group of senators introduced the “Health Care PRICE Transparency Act in a move to empower patients to lower their healthcare costs.

On a basic level, the Act will require all medical facilities to post payer-negotiated rates for all shoppable services, so the patient can find the most inexpensive way to take care of their medical needs. This legislation will give Americans the chance to see the actual costs of their healthcare visits, which in theory, will increase competition and lower healthcare costs for everyone.  

The added transparency of the Act will bring more accountability and competition to the healthcare industry, and gives American’s more control over their healthcare costs. However, if you are a medical practice, a hospital, or a member of the medical billing community, you need to know how you can best respond.

 

• “What is this procedure going to cost?”: There is going to be mounting pressure on practitioners, medical billers, and hospitals to have answers for the cost of procedures.  Jeff Leibach, a director with Guidehouse’s healthcare strategic solutions team, says that “regardless of the legal fate of the final rule, hospitals need to be prepared for more price transparency in the future.” So, to get in front of this—and help you compete against your competitors—you should be prepared with both what it will cost for individual services and procedures, as well as, a ‘value statement’ on why it will cost what you are charging.

Prepare to Comply or Cover the Costs: As it stands now, the legislation is moving towards technology assisting with the billing transparency. This will aid the patients to better understand the cost of services. This is a ‘clarion call’ for you to begin preparing for this reality or you will struggle with being fined and potentially publicly shamed in publications for being offenders. We recommend starting to comply NOW before the deadline ‘sneaks up’ on you.

Use It To Improve: Currently, healthcare practices are, in many cases, already working at capacity. The added effort of defining cost and selling procedures are enough to make some healthcare facilities put this off until it is too late. Yet, while many may be considering accepting the fines and fees associated with non-compliance, we advise using this as an opportunity to improve—to better establish your medical practice’s services, and promote your ability to be proactive to change. Getting ahead of the coming ‘wave’ of consumer expectations of healthcare will be a benefit.

Seek Out Vendors That Can Assist: The changes that are coming for individual practices and healthcare providers can be overwhelming, and potentially it might just be more than what an IT team or private practice can handle. Forward-thinking billing departments should be investing in software vendors that can help fill that gapEZClaim is a medical billing software company that partners with Trizetto to provide a tool called, Patient Responsibility Estimation (PRE). This tool assists in clarifying costs to consumers by providing a cheap and fast way for them to pay for out-of-pocket costs. [ Click here to learn more about how EZClaim can help you ].

 

It is clear that the expectations of consumers are changing, and the wave of medical transparency is on its way.  Accepting it, preparing for it, and using vendor software to help overcome it, can be the difference of your practice avoiding fines and fees. For those forward-thinking and proactive practices who want to learn about how EZClaim can help, e-mail one of their sales representatives, go to their website for more details, or download a FREE 30-day trial today!

Improve Your Billing Processes

Improve Your Billing ProcessesIf you are a member of the MEDICAL BILLING COMMUNITY, the norms of the day-to-day have changed. With the recent COVID-19 pandemic and the ‘stay-at-home’ order, you may find yourself with either more time on your hands and/or an increase of claims with new patients.  During this time, we want to offer you a couple of suggestions so that you can make the best use of the additional time you have, and also help you improve your billing processes.

The first thing to consider is to review your Accounts Receivable (AR)—to collect payments due you to INCREASE YOUR INCOME.  According to the American Medical Association (AMA), claim denial rates range between 0.5% and up to 3% or more, and that 90% of claim denials are preventable. Some of the most common claim denial reasons can be rectified by correcting claim management workflows, including claim submission and patient registration procedures. The following are a few of the most common oversights for claim denial.

  1. Use EZClaim software to check automatically for missing information, including absent or incorrect patient demographic information and technical errors
  2. Make sure you do not have duplicate claim submissions
  3. Check that claims do not have services previously adjudicated
  4. Review for claims with services not covered by the payer
  5. Make sure the time limit for claim submission has not expired

Secondly, revisit and resubmit open claims.  Surprisingly, 31% of providers still use a manual process to resubmit. Our partner, TriZetto Provider Solutions (TPS), has an Advanced Reimbursement Manager Pro (ARM) that has two great tools that can improve your ability to tackle collecting and repaying underpaid and overpaid accounts. Below are some key features that can be automated by their software, and will help to improve your billing processes:

  • Identify common errors and payer trends
  • Analyze contract performance
  • Customize and assign work into queues
  • Quickly access information from interactive dashboards
  • Automate the appeal process

Thirdly, know that EZClaim and our partner TPS have worked together to bring you the most powerful medical billing software tools to solve claim denials. Our partnership not only simplifies the billing process but also helps resolve denied claims in an efficient way. In addition to that, our customer support team is available to help you learn best practices with these tools, and support you however you need it.

Finally, if you are frustrated with your current medical billing solution, investigate how EZclaim’s medical billing solution may work for you.  You can either schedule a one-on-one consultation with our sales team or download a FREE TRIAL to check it out the software yourself. For additional information right now, contact EZclaim’s sales team at 877.650.0904 or send an e-mail to sales@ezclaim.com.

Price Transparency in the Marketplace

On January 13th we posted part one in this topic of Eligibility in healthcare, in that, we touched on deductibles, co-pay, and max out-of-pocket pay.  Now in part two, we review the impact of price transparency in healthcare and its importance to the healthcare team decisions.

 

Consumers are the most important member of the healthcare team and are better collaborators in their care when they know all the variables and their required responsibilities in the process.

The individual consumer’s healthcare team includes, along with themselves, the physician and their staff, the pharmacist, an insurance adviser and possibly some gatekeepers as well.  The communication of clear symptoms when a patient is diagnosed is the responsibility of that team along with building an understanding of the financial responsibility that goes with any medical solution.  While providing answers, options and solutions is a provider responsibility, so is providing a cost for the provided care. Therefore, price transparency can be achieved when the cost for that care is presented in a clear and concise fashion so the patient can understand what they owe, why they owe it and when it is due.

Ensuring your staff is educated on discussing the financial responsibility with the patient from the first appointment and forward will strengthen the healthcare partnership and assist in the collection process. Understanding the steps that occur post the upfront estimate can be beneficial to the team.  This discussion can be bolstered by ensuring bills are clearly marked with the statement, “this is a bill”, also clearly listing what the patient is being charged for when the bill is due and offering details on the methods of payment that are accepted.  This clarifies what insurance will cover for the patient and their own out-of-pocket cost, prompting them to share any concerns and constraints with payments upfront.

Estimating patient responsibility is one part of the reimbursement process that is used for transparency for patient billing.  The estimates can be provided using a spreadsheet of prior reimbursement and your most commonly billed CPT codes. If you would like an automated and more accurate option then look into a software tool like the Patient Responsibility Estimator by our solutions partner, TriZetto Provider Solutions  (TPS).  Giving this to the patient at the time of checking in will assure they have a rough idea of the costs and allow the office to collect upfront if needed.

For more information on how EZClaim can help you with this journey, schedule time with our sales team. Ready to get started? Download your free 30-day Trial today!

[Contribution by Brenda Smelser with the DMC]

Need Help With Your To-Do List?

Need Help With Your To-Do List?

Need help getting your To-Do list done? We have you covered!

With 2019 nearing its close, now is a great time to evaluate your revenue cycle management
and look for areas of improvement in the coming new year. Make 2020 the year you put the
focus back on your patients by automating your revenue cycle and improving your bottom line.
The best place to start is by ensuring you get your To-Do list done early!

Making the list is just like a New Year’s resolution: Easy to do but hard to complete without a
partner there to support you. The right solutions should be at the root of your strategy. EZClaim
and TriZetto Provider Solutions (TPS), a Cognizant Company, have the tools and support to
make a difference in your practice and can help you get through the list:

  1. Go digital – Check!
  2. Improve denials management – Check!
  3. Get paid faster – Check!

If these challenges are at the top of your 2020 To-Do list, get in touch with our revenue
cycle experts now to find out how we can help you check them off your list and make sure you
are ready to recoup all that you are owed in the coming new year.

In the meantime, download our infographic with the details of the financial and operational
benefits of getting your To-Do list done early this year.

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337 S. Main Street
Ste 200
Rochester, MI 48307

877.650.0904

FOLLOW US ON

CONTACT INFO

337 S. Main Street
Ste 200
Rochester, MI 48307

877.650.0904

FOLLOW US ON

CONTACT INFO

337 S. Main Street
Ste 200
Rochester, MI 48307

877.650.0904

FOLLOW US ON

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337 S. Main Street
Ste 200
Rochester, MI 48307

877.650.0904

CUSTOMER SUPPORT

337 S. Main Street
Ste 200
Rochester, MI 48307

877.650.0904

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