InstaMed Blog

The patient’s role in the healthcare payments process has evolved drastically. Ten to twenty years ago, payers and providers managed benefit and care decisions for their patients. Patients relied mainly on their health plan and geography to determine which providers to visit; and payment for services, for the most part, was handled between payers and providers.

Today, healthcare is in the midst of a shift towards a consumer-centric model, and in the process, patients have become empowered consumers who are in control of their healthcare decisions. They shop around for doctors and even health plans the way they do for other products. They check reviews online and compare pricing, just as they would to purchase a household item on Amazon. In a recent survey of consumers by LHK Partners, 91% of consumers think it is important to know payment responsibility prior to a provider visit.

Because consumers control their healthcare decisions, providers need to cater to their needs or risk losing business and revenue — this includes transparency into the costs of services.

Consider this scenario: A consumer calls a provider and says, “I’m not currently a patient, but I need a hip replacement and am in the process of looking around at different providers. Could you tell me the cost of this procedure at your hospital?”

This patient may call a dozen different providers to ask them the cost of a hip replacement before they choose one to perform the procedure. In today’s healthcare economy, consumers are outright asking to know the cost of their healthcare services, and they expect the price they receive to be the amount they will pay.

Consumers have long demanded price transparency, ever since consumer responsibility began to rise due to an increase in high-deductible health plans. Some providers have responded to consumers’ demands by displaying prices like a menu on their website. But it’s not that simple — many variables, including a patient’s health plan coverage and negotiated discounts, can change the patient’s responsibility for a service, which makes the price the provider published irrelevant. When the price you publish is not the price the patient pays, you’re no longer helping the consumer experience — you’re hurting it.

So how can providers be more transparent with patients in a way that helps, not hurts, the consumer experience? Estimate patient responsibility.

Estimating patient responsibility can be a complicated process. We recommend you follow these best practices.

Use Good Data

The best way to minimize variables that affect patient responsibility is to use good data to inform your price estimates. What are the most common services performed at your practice? What health plans do you work with most frequently? Assess these factors and use eligibility information for your patients to set up fee schedules that meet your business requirements and use cases you most frequently see. Also, be sure to use the most up-to-date information available; up-to-date eligibility information and up-to-date use cases create fee schedules that deliver accurate estimates.

Integrate Payment

Offering an estimate is only one step toward achieving payment assurance. It is crucial to get the payment side right, since this is ultimately what affects the patient. Once you give your patient a price estimate, have an easy next-step to payment. A best practice is to collect a percentage of the estimated payment upfront, then set up a payment plan at the patient’s convenience to pay over-time. This creates a positive experience for both you and the patient, because you are able to clearly establish payment expectations with the patient instead of collecting an inaccurate amount upfront and then issuing refund checks. By combining payment estimation with payment collection, you deliver a consumer-friendly experience that ensures you get paid.

Deliver Staff Training

Price estimation is an advanced solution that can be complicated. Don’t treat your estimator solely as a new technology, but also as a process change. Document the change internally, deliver training (including education, call scripts and role-play) and offer incentives for staff members who collect the most patient responsibility. The better your staff understand how estimation happens and the payment options available, the better they will be able to discuss payment with patients and the more likely you are to get paid.

Communicate With Patients

Set expectations with patients by clearly communicating patient responsibility with them. Leverage the interaction points you already have with patients to create multiple communication touchpoints. Do you speak with patients during the scheduling process? Do you send them mail or (PHI-free) emails? These are all opportunities to explain patient responsibility and discuss payment options. You can formalize the payment communication by automatically generating a printed letter to present at the time of service that explains the price estimate. Anything you can do to set payment expectations, establish the validity of your estimates and build trust with your patients will help facilitate payment conversations, improve the consumer experience and help you get paid.

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