Medical bills

Medical bills

Patients trust the hospitals and doctors who care for them, and that trust should extend to how their provider bills them for their care. This can only happen when the patient is aware of how they are billed. There are many items and services that can add to a patient’s bill, but only 14% of hospitals are fully compliant with price transparency rules, according to recent report. This can create a problem because the No Surprises Act mandates transparency and requires patients to be responsible only for in-network costs. However, more than a year after the law went into effect, a significant number of hospitals continue to not be transparent about what they charge.

Finding a solution

Not surprisingly, one of patients’ biggest concerns is the final cost of their care. They want predictability, and rightly so, as the cost of care can have a big impact on financial stability. Since the cost of care is marked by national inflation, it is imperative that providers meet their financial expectations early on. By providing consumers with a Good Faith Evaluation (GFE) – an offshoot of the No Surprises Act – patients are provided with a more accurate and transparent valuation and are in turn better protected from making uninformed financial decisions. This will strengthen the provider’s patient base because when consumers are aware of costs, they are more likely to afford their care reasonably.

As it stands, many healthcare providers calculate assessments using systems and technology that simply haven’t kept up with regulatory changes. Complex payment cycles confuse patients and their providers, often leading to missed or reduced payments, as well as inefficiencies. This is when issues begin to negatively impact the financial stability of healthcare providers as well, necessitating a transformation of the revenue cycle. It is essential that providers address costs as early as possible in the patient collection process. Through an end-to-end RCM transformation that leverages AI and machine learning tools in tandem with delivery of patient statements and an online portal that streamlines patient collection from pre-visit planning to post-visit follow-up, transparency and compliance are strengthened, creating healthcare environment that is favorable to providers, patients and payers.

Understanding costs before receiving care

Approximately 23 million patients have racked up medical debt—including 11 million who owe more than $2,000. Care plans are increasingly becoming an expensive household expense. In general, before people make a big purchase, they often compare prices and are aware of the approximate costs. Getting medical care should be no different, especially as the consumerism of healthcare accelerates. Insurance eligibility and payment estimation tools allow providers to specify during planning what out-of-pocket costs will be. By providing patients with an estimate prior to care, all parties are better prepared and aware of any necessary assistance that will be needed, including payment plans.

There is always the possibility that situations may arise during treatment that could warrant additional charges, but this is simply not something that a healthcare provider can always predict. Regardless, providing the best information about expected costs to patients ahead of time is the best course of action as it will increase point-of-sale (POS) reimbursement and help reduce bad debt associated with charge-offs. patient balances. Providers using cost estimation solutions will minimize claim denials by collecting confirmation of medical eligibility, deductible information, and copayment costs while strategizing how best to handle the financial aspects of the visit. before the patient is examined. To achieve and maintain compliance while providing patients with the most accurate cost estimates possible, providers are empowered to identify patterns in patient healthcare costs using secure, digital delivery of patient statements – enabling them to provide patients the flexibility they need.

After receiving care

Complex payment cycles can be confusing for patients and providers, but revenue cycle transformation can help reduce the number of missed payments as well as keep employers in compliance with the No Surprises Act. Using an online portal that is secure and convenient can simplify processes and communication after a patient review. Since more than half of insured patients will pay more than $500 each year out of pocket for medical expenses, workflows must be tailored to focus on higher POS reimbursement rates. By offering patients the simplicity and flexibility to pay through multiple channels, providers are better engaged in promoting patient reimbursement after care. Eliminating surprise costs encourages mutual engagement, streamlining the process for both office administrators and patients.

A revenue cycle management operation that uses the right automation and patient collection solutions helps providers better determine what a patient will have to pay for their care, creating the transparency needed to stay compliant with The law of no surprises. It also improves core processes and increases revenue while closely monitoring the risks, prices, quality and impact of reimbursements. Providing a secure and successful revenue cycle management operation that allows administrative staff to assess patient liability and accept payments at any time will create a solid foundation for an optimal patient-provider relationship.

Photo: fizkes, Getty Images

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