Beyond Patient Satisfaction: The Hidden Benefits of Accurate Upfront Cost Estimates

Providing an upfront patient cost estimate offers benefits that extend far beyond enhancing patient satisfaction. By delivering accurate, transparent cost information before services are rendered, healthcare providers can significantly improve financial outcomes, streamline administrative processes, and ensure compliance with regulatory requirements. Upfront estimates empower patients to make informed decisions about their care, leading to better health outcomes through increased adherence to treatment plans.

Improve Access and Adherence

Providing upfront cost estimates enhances patient satisfaction by fostering transparency and trust. When patients know their financial responsibilities before receiving care, they can make informed decisions, leading to improved health outcomes. Empowered patients are more likely to comply with treatment plans and follow through with necessary services, knowing they won’t be blindsided by unexpected costs.

Presenting this information in a straightforward manner is crucial to prevent confusion and ensure patients feel confident in planning for and managing their healthcare expenses.

The XiFin Patient Responsibility Estimation tool considers relevant provider-specific pricing information, test, procedure or encounter information, and real-time benefits coverage and eligibility evaluation to determine the expected patient responsibility amount. The tool displays that information in a patient-friendly, understandable format, so both the patient and the person providing the estimate can easily identify the patient’s expected expense and other details that normally appear on the insurance explanation of benefits (EOB).

In addition to the estimated patient responsibility amount, other essential information provided in XiFin’s Patient Responsibility Estimation tool include:

• Expected Reimbursement Price
• Copay Amounts
• Coinsurance Amount
• Deductible Amount
• Annual Deductible
• Remaining Deductible

Increase Collections and Decrease Write-offs and Bad Debt

Patients are more likely to pay their bills when they have a clear understanding of their expected responsibility prior to the services. Understanding the potential expenses allows patients to budget accordingly. They can set aside the necessary funds or arrange for payment plans, making it easier to fulfill their financial obligations. At the same time, having a clear understanding of service costs upfront empowers patients to make informed decisions about their care, including the option to postpone services until they are financially prepared or proactively set up a payment plan.

Implementing a patient responsibility estimator can improve collections by allowing providers to collect payments upfront, prior to services. By integrating this tool into the service workflow, providers can significantly reduce bad debt. Payment at the time of the encounter can streamline revenue cycle processes, making it easier to secure funds before services are rendered. Additionally, new features, such as text notifications, allow patients to receive their estimates via text, approve services, and prepay through a user-friendly portal.

Improve Efficiency

Providing patients with upfront cost estimations can significantly improve efficiency in several ways

• Reduced Surprise Bills: When patients know the costs in advance, they’re less likely to be shocked by unexpected bills, leading to fewer disputes and billing inquiries.
• Streamlined Billing Processes: Clear cost information can help streamline billing by aligning patient expectations with actual charges, reducing the need for follow-up communications.
• Fewer Denials: By providing accurate estimates, providers can decrease the likelihood of claims denials, as patients are better prepared to understand and address any insurance-related issues beforehand, freeing up staff time that would otherwise be spent on follow-ups and appeals.

Watch Now to see a short demo of the XiFin Patient Responsibility Estimator and explore the seamless, user-friendly features of the XiFin Provider Portal.

This streamlined process allows healthcare providers to focus more on patient care rather than administrative tasks, ultimately improving both patient and provider satisfaction.

Compliance with Price Transparency Regulations

With regulations like the No Surprises Act and the Hospital Price Transparency Act, providers are required to provide price lists and/or deliver good faith estimates to uninsured and self-pay patients prior to services. Compliance with these regulations not only mitigates legal risks but also positions healthcare providers as responsible, patient-centered organizations. This commitment to transparency can significantly enhance a provider’s reputation and attract more patients.

Ensuring Accuracy of Upfront Cost Estimations

Often, patients receive generalized cost estimates based solely on the type of service they are seeking. These estimates may lack the specificity needed for accuracy if they do not consider crucial factors such as the specific medical code (CPT, Z code, HCPCS) for the test, procedure or encounter. The estimate should contain detailed terms of the patient’s specific insurance plan or the current status of their deductible. Oversimplified or inaccurate estimates can lead to unexpected out-of-pocket expenses for patients, causing frustration and potentially impacting their healthcare decisions.

Integrating Machine Learning

The integration of Machine Learning (ML) into patient estimation significantly enhances the accuracy of copay and coinsurance estimates. For procedures with varying copay and coinsurance rates across specialties, obtaining a precise estimate from eligibility responses alone can be challenging due to conflicting rates. By applying ML, trained on recently adjudicated claims, XiFin is able to enhance the accuracy of these estimates. The ML model compiles copay and coinsurance information by payor, plan, group, and procedure, providing a “high confidence” estimate when sufficient consistent examples are available.

Monitor Payor Accuracy

In addition, XiFin can also analyze estimated patient responsibility amounts provided compared to the actual patient responsibility details received after claim adjudication. This allows providers to identify discrepancies and work with payors to resolve issues.

The XiFin business intelligence capabilities allow for an analysis of patient out-of-pocket estimates data in multiple ways, including:

• Comparison of the top paid tests/procedures and top payors, based on volume or revenue
• Payor accuracy comparisons by defined date of service, including month-to-month, quarter-to-quarter
• Patient estimation accuracy measurement by top referring client and test/procedure mix

This analysis helps ensure that patients are billed accurately and can improve the overall financial health of the provider. Monitoring payor accuracy of upfront patient out-of-pocket estimates enables providers to optimize their billing practices and negotiate better terms with payors.

XiFin Patient Responsibility Estimator Accuracy Reporting Example

The landscape of patient financial responsibility is evolving, and healthcare providers must adapt by offering transparent, accurate cost estimates. Investing in billing systems and services that facilitate cost transparency is not just a regulatory requirement; it’s an important strategic decision by healthcare providers to help them succeed in an increasingly patient-centered healthcare system.

See how Ambry Genetics utilizes the patient estimator, among other XiFin RCM capabilities, to improve collections and reduce write-offs.

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