Why self-serve estimating is integral to price transparency and consumerism

By Jit Sivalogan, Senior Director, Product Management for CarePricer and CarePricer Payment Estimator | Posted: 11/07/2019

nThrive price transparency health care solutions

The advent of ever more stringent price transparency requirements is putting easy, accurate patient estimating center stage. What was once viewed as a “nice-to-do” to help medical organization’s improve patient satisfaction is quickly becoming a “must do,” both to stay ahead of price transparency legislation and to help recoup rising patient out-of-pocket costs.

For patients, accurate, self-serve estimating is an essential enabler for health care consumerism, creating a new level of access to financial costs online. Just imagine, for instance, being able to visit multiple provider websites to cost compare on a procedure such as a knee replacement, generating estimates for each in a matter of minutes. Without access to quick, easy and accurate estimating, this is an otherwise long and cumbersome process.

While most of us wouldn’t make a major health decision solely on cost, putting such information at the fingertips of patients also improves patient education and negotiating power. Already, it is not uncommon for health care providers to give deep discounts to those who are willing to fully pay their out-of-pocket costs upfront.

Going self-serve

While some form of estimating technology is typically utilized today by health care organizations, going self-serve is a horse of a different color. To provide patients with self-serve estimates that are comparable in accuracy to those generated by staff requires not only a robust estimating engine, but also integration with an accurate Charge Description Master (CDM) and an updated Contract Management system.

Having this full technology stack ensures that the estimate reflects the patient’s current health insurance coverage, including their deductible/copay, as well as the hospital’s current charges for goods and services, which reside in the Charge Description Master.

Whereas hospital staff can see detailed terms and conditions, especially on insurance policies, most providers also want the discretion to control what the public sees to protect proprietary information.

From an implementation standpoint, providers with CarePricer can seamlessly integrate CarePricer Payment Estimator into their website to enable the self-service feature. Designed for easy navigation, the tool leads users through five steps to complete an estimate. Color coding (from lighter to darker) indicates when a step is complete. Feedback is also provided letting the user know what to do next.

Through the end of 2019, nThrive is offering existing CarePricer clients the option to integrate CarePricer Payment Estimator for free when they commit to the subscription fee.

Meeting price transparency requirements

Along with CarePricer, CarePricer Payment Estimator helps health care organizations stay in compliance with state and federal price transparency requirements as mandated by the Centers for Medicare & Medicaid Services (CMS). In January, CMS required that all U.S. hospitals post standard charges online in a machine-readable format that is updated annually. This June, the White House issued an executive ruling, outlining even more stringent requirements that are expected to be announced in a comprehensive ruling soon (read our blog here on what to expect). Ultimately, these measures are designed to provide greater patient access to hospital pricing information and health care solutions.

To date, CMS’ requirements, such as posting prices online via a CDM, are not considered user-friendly for patients and may even be increasing confusion. CarePricer and CarePricer Estimator go beyond these basic requirements, creating simple, understandable estimates that verify insurance benefits to determine patient out-of-pocket costs. Some states now require patient estimates, so this feature is especially desirable to providers in these areas.

Six states currently require estimates:

  • California (upon request)
  • Florida (upon request)
  • Massachusetts (within two days)
  • Minnesota (required)
  • Nebraska (written estimate required)
  • Texas (for elective/non-emergency)

Informed patients are better payers

Ultimately, studies show that patients who have an accurate, upfront estimate on how much a procedure will cost are more likely to pay their portion of the bill upfront, minimizing bad debt post visit. From a patient satisfaction point of view, patients with accurate estimates are empowered to make informed health care decisions regarding where they will receive care and better manage how they will pay for services.

From the patient’s perspective, most are typically not at the hospital by choice, and in some cases, it could be the worst day of their life. Avoiding the negative impact of sticker-shock when patients are already down isn’t just good business – it is good medicine. An accurate estimate of patient solutions can eliminate a lot of the stress patients experience by providing them with an accurate picture of what their out-of-pocket cost will be well before they arrive for their procedure.

Staff productivity improvements

As patients increasingly become comfortable using a self-service estimating tool, this should also free the provider staff to concentrate on other duties, leading both to increased productivity for provider staffs and enhanced patient satisfaction – a win-win for both. Better estimating will also hopefully bring provider costs down, which may lead to lower costs for patients.

To learn more about nThrive’s industry leading estimating and CarePricer solutions that can help your health care organization prepare for price transparency and consumerism, contact nThrive at solutions@nthrive.com or call us at (678) 323-2500 to speak with an nThrive expert.