On January 13th we posted part one on 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’s 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!
Because of COVID-19, some practices are doing triage from the car before they will allow a patient into their offices. Practices should also take a ‘cue’ from this by instituting protective measures for their finances.
I went to the doctor for a regular visit last week, which seemed anything but regular. I sat in the car and called to let them know I had arrived. They verified my demographics and insurance information over the phone; me in the parking lot, them in the office. The MA came out with her PPE and took my temperature, found me to be fever free so I could enter the building.
My nurse practitioner came in for our visit. We went about our appointment as usual except this time she took my superbill upfront herself and handed it to the check-out staff member. We scheduled a Telehealth visit instead of a traditional office visit. At the checkout desk, I said “I’m pretty sure I have a balance from the last visit, can I take care of that today?”. I loved where their heart is at, but I was sad to hear her say “You do, but we aren’t worried about that today. Just pay when you get the next statement.”
With so many things in chaos right now, so much thrown at you, and out of your control – let us not forget about the protective measures you can put in place for your practice. This is the time to get some vitals and triage from the car, before blindly allowing the chaos into your business. So, what should you be tracking?
Start with basics – look at the aging balances. More than likely, you have money on the table! In EZClaim, you have the option to run full aging, but the more efficient option is running the Insurance Follow Up report and the Patient Follow Up report. Just running these reports will let you know where there is money that needs to be collected. In addition – it just may show you that it is time to reevaluate policies and procedures in your office related to patient balances and insurance follow-up. Here is a peek at what these two reports can do for you.
Patient Follow Up Report: This report will show you balances that are outstanding with your patients. While this may not be the easiest time to ask patients to pay their balances, there are steps you want to consider:
Consider what you will do with lingering patient balances. The Patient Follow Up report will show how many statements have been sent since the last patient payment. If you have sent several statements is it worth continued efforts?
Contact your patients to see if they can pay with an HSA or FSA account
Offer to set up a payment plan
Write off the balance as a bad debt or a one-time professional courtesy
Consider sending the account to collections
Use technology to your advantage. Take this time to consider enabling online payment options.
Create or revise patient payment policies and train your staff on these policies
Insurance Follow Up Report: This report will show your balances that are outstanding with insurance companies. Some of the useful features of this report include:
Ability to see the aged balances by the payer. This lets you get the biggest bang for your buck. Look for payers that have a large percentage of balances in the oldest buckets and work those first.
All the information you need for calling the insurance is right there on the report. You will have easy access to the date of birth, member ID number, and claim totals on the report.
During your research, you will find common themes. Use these themes to update your office procedures and train your staff to eliminate errors so that claims get paid quicker.
EZclaim billing software can help you manage your office’s finances. Visit our website to find out more about our solutions: https://ezclaim.com/
[ Contribution by Stephanie Cremeans with EZClaim ]
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:
Go digital – Check!
Improve denials management – Check!
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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