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3 Things Your Patient Bill Estimation Tool Should Give You

August 10, 2018

by Marcia Leighton, Executive Director, Client Services

As an industry, we are beginning to really recognize and value the need to inform our patients of their out of pocket expense before their services, and eliminate any “sticker shock” the patient might feel at time of registration or once they receive their statement.  We see that when we generate and communicate accurate out of pocket expenses and work to secure agreeable payment arrangements before their service, that our patient collections increase and back end vendor costs decrease. This swing in revenue opportunities is placing a premium on accurate bill estimation tools.

When we begin to think of estimation tools as a comprehensive source of key data analytics, we can realize the full potential.  In general, estimation tools should be able to determine patients out or pocket, and they should also be able to provide you with these three additional components to help you understand your data in order to make continuous improvements. 

1.    Calculate estimations down to the physician level.  This means that when an estimation is completed, physician-specific charges for each procedure will be included. This provides insight into ordering practices the can increase patient out of pocket unnecessarily, as well as the impact of those practices that lead to higher denial rates from unauthorized services. Here are two examples that highlight the importance of this: 

  • Dr. Smith typically uses a different higher cost set of drugs while performing an injection than all the other physicians who perform the same procedure.  If your estimation tool does not calculate at that level, then you risk patients with Dr. Smith being informed they will owe less than what their actual bills will reflect.  
  • Dr. John orders a Diagnostic Colonoscopy for all of his patients, but 90% of the time he also performs a tissue biopsy and EGD.  As a result, his claims are denied and you have again communicated to the patient an incorrect out of pocket estimate. 

2.    Include the estimated allowable insurance so that you can compare to the actual reimbursement received from the insurance company. As our patients out of pocket expenses continue to grow, you’ll need safeguards like this to ensure that you are receiving every penny of earned income from the insurance companies.

3.    Identify and report any significant drops or changes in revenue from month-to-month for:

  • Estimations for specific CPT/Procedure codes so that you can quickly identify drops in higher dollar services  
  • Your estimation tool should provide you with the ability to run reports showing estimations by CPT/Procedure code.  This will let you identify any significant drop in those higher dollar services.  
  • Your estimation tool should provide you with reports showing drops in physicians’ ordering/performing procedures at your facility. 

By expanding the role your estimation tools and procedures play in your patient access system, you’ll begin see your revenue cycle in a different light, and have the data to recognize opportunities for improvements!