The face of healthcare, especially pathology, is changing. Patients are carrying more of a financial burden for their care, creating more consumerism. They expect two things from their providers: quality healthcare and price transparency. It’s no longer acceptable for many patients to not know what they’re getting into when receiving medical care. If they don’t know their costs upfront, they likely will go elsewhere to a provider offering price estimation, prior authorization, patient payment solutions, and additional digital tools for engagement.
"Imagine has taken the administrative headaches of practice management off my plate, giving me more time to be a pathologist."
—Dr. Kevin Homer, Huguley Pathology Consultants, PA
Stressful Patient Billing Surprises
Opening the mail only to find an unexpected medical bill can be very stressful. It’s even worse when the amount of the bill is much higher than expected – Especially for lab work and tests. That’s one of the reasons what’s referred to as “surprise billing” has become such a hot-button issue for both patients and politicians over the past few years.
Astronomical costs along with a lack of price transparency often deter patients, especially those without health insurance, from receiving care. Some patients often receive medical care without knowing the exact price, even though they face high and varying out-of-pocket fees for their care. Others never stop to question whether they were charged correctly or whether their insurance was ever billed.
Even patients who have health insurance often struggle to pay their medical bills. Almost 80 million Americans either aren’t able to pay those bills or are paying off medical debt. Two-thirds of individuals who file for bankruptcy cite medical issues as a key contributor to their financial downfall.
Surprise Billing Legislation
Data from PatientsRightsAdvocate.org shows that 85 percent of Americans believe that cutting costs and improving quality by making healthcare prices, quality metrics prices, quality metrics and outcomes more transparent should be a priority for lawmakers. Lawmakers have listened. Legislation over the past few years designed to curb surprise medical bills and spur price transparency includes the Hospital Price Transparency Rule, the Transparency in Coverage Final Rule and the No Surprises Act.
The Hospital Price Transparency Rule, which effect on January 1, 2021, requires each hospital operating in the United States to provide clear, accessible pricing information online about the items and services they provide in two ways: as a comprehensive machine-readable file with all items and services or in a display of shoppable services in a consumer-friendly format. Many hospitals haven’t yet achieved compliance with the rule, though. As of February 2022, only 14 percent of hospitals had met compliance with the rule.
The Transparency in Coverage Final Rule was issued in October 2020 as part of the Consolidated Appropriations Act. In effect from July 1, 2022, it requires most group health plans and health insurance issuers in the group and individual market to disclose price and cost-sharing information to participants, beneficiaries and enrollees.
The first surprise billing legislation passed on the federal level is the bipartisan No Surprises Act, which went into effect on January 1, 2022. It prohibits out-of-network providers from billing patients more than in-network cost-sharing amounts for the following:
- All out-of-network emergency facility and professional services
- Post-stabilization care at out-of-network facilities until such time that a patient can be safely transferred to a different facility
- Air ambulance transports, whether emergency or non-emergency in nature
- Out-of-network services delivered at or ordered from an in-network facility unless the provider follows the notice and consent process
For medical billing companies, the most important part of the act may be the independent dispute resolution process, which requires providers to work with payers to settle on fair prices. If these two parties don’t reach a voluntary agreement in a 30-day negotiation period, an arbitrator will be selected to pick one of the submitted amounts.
The Benefits of a Price Estimator
Imagine full transparency of out-of-pocket costs and payment options at the time of service – Implementing Patient Estimation tools makes that a reality for providers’ patients. This increased clarity helps improve not only the patient experience, but also cash flow and workflow efficiency.
Benefits for Providers:
- Improves cash flow and revenue cycle to address High Deductible Plans
- Reduces statements, labor costs and bad debt
- Estimation provides patient education on their balances
- Facilitates payment of the growing consumer liability
- Minimizes calls from patients and to payors, questioning payment outcomes, benefits and eligibility
- Creates a more efficient, stress-free environment and staff
- Improves patient satisfaction
Benefits for Patients:
- Reduces confusion about balance owed
- Allow patients to know out-of-pocket costs at time of service when payment options can be discussed
- Increases level of satisfaction with provider
- Provides payment flexibility
- Price transparency
The Benefits of Prior Authorization
Automation technology empowers physician practices, hospitals, and health systems to easily manage the validation of new and existing authorizations. Initiating authorizations efficiently and intelligently allows practices to minimize manual tasks and lost revenue from rescheduled or missed authorizations.
- Centralized Dashboard to Manage Your Day
- Reduced Labor Efforts from Exchange EDI Automation
- Eliminates Missed or Rescheduled Authorizations
- Integrated E-Fax Solutions So All Users Have Faxing Capabilities
- Auto-Post Results Back Into All Major PM / EMR Systems
The Benefits of a Patient Payment Portal
The payment portion of any medical appointment/procedure is never fun, but it should be easy – for both providers and patients! Implementing an all-in-one patient payment portal streamlines the payment experience for both parties, with flexible payment plans, multiple payment options, and a robust single dashboard for real-time reporting.
Benefits for Providers:
- Auto Notification to alert Patient balances via text or email
- Reduce statements as Patient opt in for e-statements
- Patients can choose a payment plan that fits their budget
- Reduce backend work as payments auto-post back in system
Benefits for Patients:
- Easy registration and Login process
- Accepts Visa, MC, Amex and ACH
- Several payment plan options
- Login from your PC or mobile device
- Email or text notifications
At ImagineSoftware, our ImagineSimplicity™ solution provides patients with a clearer view of their financial responsibility. Available in a standalone version or integrated with Clinisys’ solutions, it increases collections through transparent pricing and easy payment proccesses. Request a demo to learn more!