Patient Engagement in the Eligibility, Estimation, and Payments Processes

, | March 26, 2017 | By

So far, we’ve considered how patient engagement can be enhanced by improving your workflows for scheduling, pre-registration, and access to results. 

But what about the patient eligibility and patient payments processes?

Unfortunately, it’s all too common for patients to have a difficult time determining whether they’re eligible to be seen at certain locations or to receive coverage for specific services.  

It’s also common for them to receive services, then – possibly months later – receive a statement for a dollar amount that gives them sticker shock, because they received little to no upfront information about their portion of the cost.

Experiences such as these can have a significant detrimental effect on a patient’s view of a healthcare provider and on his or her willingness to engage again in the future.

Are you in the business of patient care or paperwork?

As is almost always the case, when opportunities exist to improve the patient experience, there are equal – or even greater – opportunities to improve the experience for the healthcare practice as well.  

If your practice is like many others, there’s a good chance that your staff are spending an enormous amount of time engaged in the manual process of determining eligibility and that your cash flow is hampered by waiting for patients to respond to paper statements for services rendered.  

Collecting payments from patients is an enormous problem for practitioners, particularly in this era of high-deductible health plans, but as a story by NPR revealed, emphasizing an upfront payment model can significantly reduce the bad debt that a practice must carry.

Why is accurate estimation so challenging?

Healthcare providers often are unable to provide patients the accurate and reliable estimations that are necessary for upfront payment.  A number of data elements need to be brought together in order to do this, and existing technology systems simply can’t bridge those gaps.  

The problem lies in the number of data elements that need to be considered:  

  • the practice’s fee schedule for their billing codes
  • existing patient balances
  • benefit eligibility for the current services
  • ...and more. 

In a typical healthcare practice, these data exist in separate silos; however, a cutting-edge estimation solution will consolidate the data and will have the right formula and rules to ensure that patients receive accurate estimations.

What would an improved workflow look like?

With an intelligent solution in place, your practice can not only have real-time, automated verification of patient eligibility, without manually calling or checking multiple payer websites, but can also quickly and accurately provide estimations of your patients’ financial responsibility.

The result for patients is that they will have a clear understanding of their estimate at the time of service and that they can even ease their monetary concerns by establishing a payment plan right from the start.  

For the healthcare practice, this provides an opportunity for on-site payment, resulting in immediate increases in daily revenue and decreases in paper statements.  When statements do need to be sent, both electronic and paper statements should be supported, and patients should be able to easily view their balances and pay online at their convenience.

The bottom line is…

For the benefit of both patients and staff, healthcare practices need to move away from outdated estimation and payment processes and embrace automation.  

Rising healthcare costs mean that patients have greater financial responsibility than they did in previous years and that they must become well-informed consumers of medical services.  

Likewise, healthcare practices need to disentangle themselves from paperwork, collect the payments that keep their doors open, and focus on their true purpose: providing quality care.


How do you feel about your patient payment processes?


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