Accurate Patient Responsibility Estimates Dramatically Improve the Patient Experience

Customer experience is one of the most significant long-term differentiators in healthcare and diagnostics, as it is in virtually all other sectors. There is a direct correlation between customer experience and engagement, and consumers have been trained to expect more when it comes to service and experience by companies such as Amazon, Apple, and Southwest Airlines.

Additional patient concerns included not knowing:

• What or how much treatment their insurance would cover
• How much their insurance would pay
• How much out-of-pocket expenses they will incur

Clearly, patient responsibility visibility is a top priority for consumers. Too often, patients are getting an unhappy surprise when they receive a billing statement with an unexpectedly high amount due. This is undoubtedly a negative customer experience. With inflated co-pays, more participation in high deductible insurance plans, and higher claim denials due to issues with prior authorization, patient responsibility is at an all-time high. The patients themselves now shoulder approximately 30% of all healthcare revenue.

Let’s look at what payors and providers can do to help automate, provide access to, and improve the accuracy of patient payment responsibility estimates. XiFin RPM now provides a patient responsibility estimator as part of its patient service center capabilities. Most estimators available in the market today use only a portion of the data needed to calculate an accurate forecast of the patient responsibility. XiFin RPM has all the data required and as such, creates a much more precise patient responsibility estimate. The data leveraged by the XiFin Patient Responsibility Estimator includes the expected reimbursement at the CPT code level, by payor plan, along with real-time eligibility information. Together this data enables us to calculate an accurate estimate of what should be collected from the patient at the time of service or at the time of order.

The patient responsibility estimator has an easy-to-use screen to enter the patient demographic and insurance information. The estimator also takes into account any relevant provider-specific pricing information as well as the test of procedure information. This functionality enables us to calculate the amount of the expected payor reimbursement (i.e., the CPT code reimbursement amount) once billed. The system then marries this data with the real-time eligibility transaction from the payor to determine the patient responsibility amount. This amount is displayed prominently on the screen, so it’s easy to see and comprehend for the patient.

In addition to the patient expected amount due, the screen also displays the details behind the patient responsibility estimate, including any co-pay, co-insurance, deductible, and remaining deductible at the procedure level. This is essentially the data that a patient typically sees on an explanation of benefits statement, only it’s presented much earlier in the process, preventing an alarming surprise to the patient weeks after the test or procedure is completed. Once the patient expected amount due is calculated and shared with the patient, the XiFin RPM system is able to collect any pre-payment and provide the patient with a receipt. XiFin RPM also provides a provider-specific patient portal, where patients can access their billing statements and make any additional payments.

Providing patients with the information they want to know upfront before a test or procedure is completed, gives them confidence that there will be no surprise bills weeks after the procedure is complete. In fact, the XiFin Patient Responsibility Estimator addresses each of the concerns about the patient financial experience articulated in the Experian Health research study. Patients will now know precisely what their insurance will cover and how much they will pay, so their out-of-pocket expenses will be clear. Visibility and clarity of information go a long way toward improving the patient experience.

Interested in discovering more strategies to improve patient engagement and physician satisfaction? View our complimentary on-demand webinar.