Accurate Patient Charge Estimation a Fantasy?
31
This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients and may not be shared with vendors outside of Craneware. Accurate Patient Charge Estimation – a Fantasy? aIPAM
Transcript of Accurate Patient Charge Estimation a Fantasy?
This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipients and may not be shared with vendors outside of Craneware.
Accurate Patient Charge Estimation – a Fantasy?
aIPAM
© 2017 Craneware
craneware.com
aIPAM
Patient Access The Unsung Super Hero
© 2017 Craneware
craneware.com
aIPAM
© 2017 Craneware
craneware.com
aIPAM
Start with Why
Simon Sinek
© 2017 Craneware
craneware.com
aIPAM
Why are you in Healthcare?
© 2017 Craneware
craneware.com
aIPAM
Why an Estimate?
The Patient is asking for it (yes they are!)
The patient should know that we charge a lot which means we are really good
I believe it is important that the patient is aware of their responsibility
I want to help the patient deal with their financial obligations
I really don’t - my job is registration
We should be transparent about what we charge
Just Because
I want to be able to collect what the “customer” owes our business
Because my Competition is providing them
© 2017 Craneware
craneware.com
aIPAM
© 2017 Craneware
craneware.com
aIPAM
If we provide an estimate to a patient and don’t provide a financial plan
are we fulfilling our “why”?
How do YOU become the hero?
© 2017 Craneware
craneware.com
aIPAM
© 2017 Craneware
craneware.com
aIPAM
Estimate Elements
Procedure Charges
Patient Contributions
Patient Plan
© 2017 Craneware
craneware.com
aIPAM
Procedure Charges
© 2017 Craneware
craneware.com
aIPAM
Hospital Charges
Payer Negotiated
Rate
Procedure Charges
Data Sources• Cheat Sheet• ChargeMaster• 835’s• Payer Contracts
© 2017 Craneware
craneware.com
aIPAM
Patient Plan
Co-Pay
Co-Insurance
Deductible
3rd
Party
© 2017 Craneware
craneware.com
aIPAM
Eligibility / Patient Responsibility
• Most Vendors share Payer data from a few select EDI Vendors
• Augmented with Screen Scraping/Bot technology
• The raw data needs formatting
• Multiple patient experiences may result in temporary inaccuracies
© 2017 Craneware
craneware.com
aIPAM
Patient Contributions
Previous Events
Current Events
Family Events
© 2017 Craneware
craneware.com
aIPAM
It’s Complicated
But how perfect does it have to be?
© 2017 Craneware
craneware.com
aIPAM
© 2017 Craneware
craneware.com
aIPAM
If a train going southbound at 100MPH….
• Hospital has Current Charges of:
• $3,200
• Patient has an Insurance plan of:
• $100 Co-Pay
• $2,500 Deductible
• $20% Coinsurance
• Patient has already paid:
• $600 on MRI
Paid $150 on Office Procedure
© 2017 Craneware
craneware.com
aIPAM
Affect of Changes in Estimate
$2500 – $600 already paid = Remaining Deductible of $1900$3200 – $1900 Remain Deductible ($2300) x 20% = Co-Insurance of $460Total Patient Responsibility = $2360
$2500 – $750 already paid = Remaining Deductible of $1750$3200 – $1750 Remain Deductible ($2150) x 20% = Co-Insurance of $430Total Patient Responsibility = $2180
Difference is $180 - is this acceptable?
© 2017 Craneware
craneware.com
aIPAM
Who Can Pay and How?
Do Pay Don’t Pay Can’t Pay
© 2017 Craneware
craneware.com
aIPAM
What do we do now?
© 2017 Craneware
craneware.com
aIPAM
Patient Charges
Estimated
Patient Payment
Plan is Created
PayorRemit
Claim Adjudicated
Patient Balance Adjusted
Denials Managed
Patient Balance Posted
Patient Financial Process
Insurance Eligibility Verified
Submit Claim
Refunds Processed
Payor Remit Posted
© 2017 Craneware
craneware.com
aIPAM
• Average amount Collected from Patients Per Dollar Owed once they walk out of a hospital… post adjudication
Trends in Patient Engagement
© 2017 Craneware
craneware.com
aIPAM
Verify Eligibility
Submit Claim
PayorRemit
Remit Posting
Denial Mngmt
Patient Collections
Patient Balance Posting
Process Change
© 2017 Craneware
craneware.com
aIPAM
Verify Eligibility
Submit Claim
PayorRemit
Remit Posting
Denial Mngmt
Patient Collections
Patient Balance Posting
Process Change
© 2017 Craneware
craneware.com
aIPAM
$$$$$$ paid over 8 MonthsDay 0 30 60 90 120 150 180 220 250
Patient Wellness Journey
Patient Financial Journey
Hospital Claim Journey
1$ 2$ 3$ 4$ 5$ 6$ $
© 2017 Craneware
craneware.com
aIPAM
If we provide an estimate to a patient and don’t provide a financial plan
are we fulfilling our “why”?
How do YOU become the hero?
© 2017 Craneware
craneware.com
aIPAM
Requirement: Everyone has a Financial Plan
© 2017 Craneware
craneware.com
aIPAM
Capabilities Required to Support Everyone Having a Financial Plan
Must Work with Elastic/Dynamic Patient EstimatesAllows for Financial Plan Creation Prior to Patient DischargeOperates within Payment Plan PoliciesPlan is technically connected to Claims AdjudicationAllows Automated Patient Payment AdjustmentsAutomated Payment Posting of Account Payments and BalancesPatients Require Consistent Digital Communication
Verify Eligibility &
Estimate
Submit Claim
Payor Remit
Remit Posting
Denial Mgmt
Patient Financial
Plan
Patient Balance Posting
© 2017 Craneware
craneware.com
aIPAM
Better Outcomes for All
