The healthcare industry continues to demand more transparency to the patient as more responsibility for rising costs in premiums and deductibles are passed to the patient. This can occur for some patients by shopping across organizations, requesting estimates for services or simply checking eligibility on line to understand the out of pocket expense prior to the service. These tasks seem simple to a computer savvy millennial using their smartphone. For other patients, it may be a phone call into the doctor’s office requesting an estimate for the cost of services. The complexity of the plan options, combined with the type of service, provider specialty, and place of service can dramatically affect the results on the patient’s liability and ultimately their patient satisfaction when receiving their statement.
Fortunately, if you are an Epic user, there is an electronic solution to solve this complex issue with Real Time Eligibility integration and Patient Estimates. The user can request estimates and check eligibility on the patient portal and the integration with the application allows the information to be pulled over for consistency. The integration of the Real Time Eligibility and Benefit Collection information allow the functionality of the system to work at the optimal level. The workflow then allows conversations with the patient prior to their appointment around the out of pocket expenses so there are no surprises once the statement is received.
This best practice integration and workflow:
- Ensures collection of the correct co-pay at check-in
- Enables you to differentiate co-pay charges depending on type of visit
- Improves point-of-service collection rate at check-in
- Reduces credits to refund patients on the back end
- Reduces incorrect co-pay amounts billed to patients
Several organizations already have Real Time Eligibility running in the organization yet are unaware of the integration to the Benefit Collection Form with the data. An assessment of the current state workflow for the integration of the real time eligibility, patient access and estimate workflow compared to the best practice workflows could benefit your organization in this time of change in healthcare.