Regardless of the New Final Rule, Use Price Transparency as a Springboard to Delight Your Patients

A CMS deadline on healthcare price transparency looms on the horizon, requiring hospitals to provide meaningful pricing information to patients for “shoppable” services.

But with some of the most powerful organizations in the industry challenging the new rule and filing lawsuits, the January 2021 compliance date might be in question. Regardless of the outcome, compliance is not the only reason hospitals should be working hard on this strategic imperative. Meaningful price transparency should be important to hospitals simply because it’s important to patients and to your hospital’s bottom line.

Here’s why: Accenture’s 2019 Digital Health Consumer Survey shows 65% of consumers say cost transparency is even more important to them than traditional measures of patient satisfaction, such as convenience of appointment times, wait times, appointment length and the convenience of the location.

So clearly, hospitals have good reason to invest in price transparency solutions.

Benefits Beyond the Healthcare Price Transparency Rule

To meet the rule’s basic requirements, providers need to:

  1. Make standard charges for 70 CMS-specified and 230 hospital-selected services available in an online data file that can be read by computer systems; those same 300 services must also be available online in a consumer-friendly format that does not require a person to identify themselves
  2. Provide a list of the minimum and maximum charges for those 300 co-called “shoppable” services on their website

While those requirements might make healthcare prices less opaque, they won’t be very meaningful for consumers if adopted in a way that simply meets the “letter of the law.”

Patient price estimates are the key to delivering consumer-friendly, meaningful price transparency to patients. Hospitals should use this opportunity to not only meet the compliance requirements, but also to offer user-friendly tools that actually provide the information patients want—expectations of their out-of-pocket costs. Plus, creating a dialog with patients about what they will owe for their care earlier in the revenue cycle process provides clear business benefits to hospitals by increasing point-of-service collections and by collecting earlier in the process, thus decreasing the overall cost to collect and eliminating bad debt.

How Patient Estimation Software Can Help

To deliver meaningful and actionable healthcare cost transparency, hospitals must offer insight into patients’ specific, customized out-of-pocket costs for a specific procedure, including all the likely ancillary charges that usually come with the service. To provide those cost estimates, you need visibility into:

  • Negotiated price for service
  • Charges for services customarily provided in conjunction with the primary service
  • Specific benefit coverage and rate
  • Deductible and remaining balance
  • Co-insurance impact on the amount the patient will owe

The good news is that you’re likely already gathering most of this information. In fact, 87% of providers have the ability to share cost estimates but only 18% of patients currently get one without asking. It’s just that many hospital revenue cycles are not set up to provide this information prior to service or in a consumer-friendly manner. This is key because it gets to the heart of why revenue cycles are so inefficient.

To change this for the better, for both the hospital and the patient, the answer is to offer online, patient-facing cost estimation tools. Many hospitals already provide staff-generated patient payment estimates, but very few offer patients self-service tools that can enable them to “shop” for services.

While providing these tools directly to patients is a big change culturally, implementation is seamless. For example, AccuReg’s patient estimation solution, which powers patient-facing estimations, operates from the same platform that our customers’ registration staff already uses to provide price information to patients.

Use Patient Price Estimates to Improve Patient Financial Experience

By providing patients with tools that deliver insight into coverage for specific services and the scope of cost-sharing obligations—including out-of-pocket spending limits, deductibles and co-insurance, and estimates of the cost of a total episode of care using benefit-level eligibility verification—you commit to improving the patient financial experience and to becoming a more patient-centered organization, which in turn improves your bottom line.

Not only will you prepare to meet CMS price transparency requirements, you’ll be ahead of the competition. Using patient estimation software, your hospital gains the ability to offer pricing information others don’t, as well as other benefits, including the ability to:

  • Provide scheduled patients with pre-service estimates
  • Decrease the need for patient billing on the back end of the revenue cycle
  • Create a collections culture that increases net revenue
  • Collect more cash at the time of service, or even prior to service
  • Empower your staff to explain what patients owe in terms they understand
  • Improve patient satisfaction

To learn more about our patient estimation software and how your hospital can provide patients with the cost transparency they need, download our latest e-book, Strategies for Delivering Price Transparency that Matters.

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