The Link Between Patient Satisfaction, Billing, and Profitability
January 26, 2023
A patient’s billing experience is the last impression that influences their satisfaction with their medical care team. Even for diagnostic providers without direct patient contact, a dissatisfied patient can result in delayed payments, patient complaints, and loss of referrals. Satisfaction impacts the patient’s probability of returning to the provider and paying their medical bill.
So, what can you do as a medical provider to improve patient satisfaction during the billing process?
Ensure the Accuracy of the Patient’s Billing Statement
The easiest way to increase patient satisfaction is by implementing billing processes that maximize payor payment, thus reducing the patient’s financial responsibility.
Claims are denied for a variety of reasons, and require different follow-up actions. Some denials can be addressed through a corrected claim, some require appeals, and some require billing the patient directly. Your response to the denial will vary based on the denial reason.
While providers can’t control payor denial policies, they can help improve patient satisfaction by evaluating, correcting, or appealing denials, before sending a billing statement to the patient.
Below are five billing processes that can be implemented to ensure the accuracy of the patient billing statement and minimize patient phone inquiries about why their health plan denied the claim.
1. Evaluate Claims with a “Patient Responsibility (PR)” Denial Code
Often a claim will be denied, and the entire charge will be shifted to the patient’s responsibility with the PR denial code. When this happens, reviewing other remark codes on the EOB is important in determining the reason for the denial before billing the patient. Implementing front-end processes such as insurance discovery, insurance eligibility verification, and prior authorization capabilities can help minimize these types of denials.
2. Obtain Accurate Patient Demographics
This is essential to seeking reimbursement and streamlining patient communications. To avoid claim denials related to missing or inaccurate demographics, providers should have a process in place to efficiently collect missing or inaccurate patient demographic information and provide it to the biller prior to billing the patient.
3. Verify Patient Insurance Coverage and Service Eligibility
Confirm insurance eligibility before completing a test or submitting a claim can result in fewer denials and improve the patient experience. The best eligibility verification solutions provide comprehensive, real-time eligibility screening that validates the patient’s insurance is active, identifies any secondary insurance for the patient, and gets to the plan level to confirm the co-pays, co-insurance, and deductible.
4. Monitor Payor Denial Patterns and Implement Processes to Meet Payor Requirements
Every payor has different policies and requirements for payment. Therefore, it is essential to monitor denial patterns by payor and implement front-end payor-specific edits to prevent denials.
5. Implement an Appeals Strategy Combined with an Automated Appeals Process
Automating components of the appeal process ensures efficiency, reduces manual and cumbersome responsibilities, and allows more time to focus on more complex denials. In 2020, appeals accounted for 5% of total revenue generated by XiFin customers; they increased 30% in 2021.
Provide Out-of-Pocket Financial Expectations Prior to Services
Patients who are aware of their financial responsibilities prior to receiving a service are more likely to pay. This translates into fewer resources being needed to collect on the back end and a decrease in uncollected bad debt.
Within the past two years, regulatory requirements have been implemented to educate patients on their “upfront cost” prior to receiving a service, including the Hospital Price Transparency Rule and good faith estimate requirements under the No Surprises Act. While these requirements impact hospital services and self-pay patients, providers should also consider providing upfront financial expectations to insured patients in all settings.
Payors are shifting a larger portion of the payment to patient responsibility and limiting service coverage. When patients receive a billing statement, they are often surprised at the amount their insurance did not pay and instead shifted to patient responsibility.
How can you help? An accurate patient responsibility estimator can help improve patient engagement and ensure patients are not blindsided by an unexpected cost. This allows providers to collect balances at the time of service and allows staff to discuss with the patient payment options and plans for payment.
A patient responsibility estimator tool allows providers to:
- Collect Patient Information – Easily collect the patient demographic, insurance information, and tests or procedures being performed.
- Identify Expected Reimbursement – Through integration with billing, the patient information collected can be utilized to confirm insurance eligibility and determine the expected payor reimbursement when billed.
- Provide an Accurate Patient Estimate – Accurate estimates of a patient’s expected out-of-pocket expenses under their payor-specific health plan that considers copays, coinsurance, and deductible amounts from the billing system can be provided.
- Increase Payor Payment Accuracy – This can also be utilized to monitor insurance payment accuracy. Comparing the estimated payment provided to the patient to the actual payment from the payor, allows monitoring of accuracy by test, payor, and client.
Continually Evaluate and Enhance Your Patient Engagement Portal
A patient portal is a secure online website that gives patients convenient, 24-hour access to personal health information from anywhere with an Internet connection.
An online patient portal is no longer considered a “value-add service” but is really a requirement for patient retention and financial stability. Part of improving patient satisfaction is meeting the patient’s needs during the payment process. Patients want better cost transparency, flexible payment option, and more modern engagement opportunities.
Patients are seeking secure online engagement portal which allow them to:
- Access digital payment options, including credit card payments and PayPal, along with real-time support
- Set up and manage payment plans, and execute pre-payments or partial payments
- View a summary of all statements, payment history, and outstanding balances
- Electronically review and update insurance or demographic information
- Upload photos of their insurance cards electronically
- Select statement and notification preferences, including paperless statements and email or text reminders
- Access invoices that are easy to understand, and relevant explanations of benefits (EOB)
- View and approve estimated out-of-pocket patient responsibility estimates before service
- View statements, pay bills or update information through user-friendly and convenient patient touchpoints
Providers should continue to evaluate their patient portal and identify ways to offer new engagement and payment options. For example, in 2022, XiFin began sending a combination of patient statements and text notifications to patients regarding their outstanding balances. As a result, the volume of revenue received from patients in the first 30 days of the billing cycle increased by 26.6%.
In summary, the patient experience does not end with treatment; it continues through the billing process. Your patient’s financial experience during the billing process has a significant impact on their satisfaction. A satisfied patient translates to a repeat patient, positive patient reference, and increased revenue for you. The billing experience is one of the most common influencers of patient satisfaction, and efforts to improve the patient revenue cycle experience are critical. Patients are more likely to pay their bills when they believe the statement is accurate, are educated on their estimated patient responsibility, and have access to user-friendly online patient engagement tools.
See how diagnostics innovators Ambry Genetics, BioReference, and Pathnostics are leveraging XiFin capabilities to transform their patient and physician experiences and to improve their bottom line.