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Myndshft Blog

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June 14, 2022

Transparency vs Status Quo: Why Point-of-Care Patient Financial Responsibility Calculations Up Your Star Rating

by Susan Lawson-Dawson | Healthcare Administration, News

Long before patients sit down face-to-face with a clinician—in person or virtually—they have already begun to form opinions about their experiences. Is the patient experience you’re delivering good or bad? Patients attitudes could depend on whether they know how much the service you’re providing will cost.

The price transparency mandate that has been in force for providers since January 2021 doesn’t quite get them there. The rule set by the Centers for Medicare and Medicaid Services for “clear, accessible pricing information online” is a start, but to date, compliance has been lagging.

In addition, such published lists don’t account for variables like patients’ benefits eligibility, co-pays, and deductibles—all of which influence the final bill that a patient receives. Payers have a similar rule about to go into effect in July 2022. Based on the slow start for provider compliance, payer-side transparency is likely to take time too.  That’s why having a patient financial responsibility calculator at the point of care is a must.

Bad Billing Experience = Bad Patient Experience

Today’s healthcare consumers are incentivized by high-deductible plans, monthly premiums and copays. High stakes lead to high expectations. They want connected, personalized, and convenient experiences (with accurate prices)—just like they get from their favorite brands.

Citing a 2021 Healthcare Consumer Experiences Study, Healthcare IT Today  notes that 93% of healthcare consumers said the billing and payment experience is a deciding factor when choosing a healthcare provider.   Other factors include: 

  • Network affiliation: Is the provider in or out-of-network? 
  • Location: What is the provider’s distance from home or office?
  • Experience: How many years of experience does the provider have? 
  • Availability: How long does it take to get an appointment? 

Making answers to these questions readily available online, along with cost transparency, ensures healthcare consumers are better informed before they make a choice. Even then, you’re starting from a tough position compared to other consumer-focused industries.

Clear Patient Financial Responsibility Helps with Hurdles

Unlike shopping for the latest fashion or must-have device, however, people come to healthcare providers because they have to, not because they want to. Patients feel stressed out, uncertain, and fearful—which is one reason telling them what an episode of care will cost before they move beyond the front desk is important. A different healthcare consumer survey found that 44% of patients avoided care because of cost uncertainty and nearly 90% of patients want accurate information about their financial responsibility before accessing care.

The Healthcare IT Today article further notes, “There is a myth that patients would go running for the hills if they knew how much their care will cost them up front. It turns out, patients only go running for the hills when they are hit with surprise bills. Knowing the cost up front is not a deterrent.”

According to the study data, in fact, 79% of healthcare consumers expressed willingness to pay out-of-pocket costs before or at the time of a visit if they have a guarantee: No surprises later. How do you address healthcare consumers’ expectations and concerns?

Start with Real-Time Eligibility & Benefits Verification

Before patient financial responsibility can be accurately calculated, you need to confirm your patients’ insurance coverage. At the same time, you need to meet your patients’ expectations for fast, convenient service: Think Amazon-level response times.

Unfortunately, manual eligibility and benefits verification is only surpassed by prior authorization in terms of time-consuming, costly administrative transactions in healthcare settings, according to the 2021 CAQH Index®. The time savings opportunity of switching to electronic eligibility and benefit verification is 21 minutes per transaction.  A faster process leads to faster service, which your patients appreciate. The time savings also promises a significant cost savings opportunity of $9.8B annually across the healthcare industry.

Real-time eligibility and benefits verification through Myndshft establishes an individual’s medical benefits coverage based on the particular plan and service. Covering 94% of U.S. covered patients, Myndshft instantly identifies accurate co-insurance, copay, deductible and other plan details. 

Myndshft goes a step further with insurance discovery, locating all available coverage—even third-party payers patients may have forgotten or been unaware of. This eliminates the need for time-consuming manual searches or inaccurate billing that leads to reimbursement delays or denials (and contributes to patients’ cost anxiety). 

Ensure Accurate Patient Financial Responsibility Calculations

By establishing this level of detail, Myndshft uses both your patient’s current insurance information and your contracted rates (if available) to automatically—and accurately—calculate patient financial responsibility. In addition to satisfying a critical patient expectation, this can help you keep your revenue cycle running smoothly. 

  • Collect payment at the point of service
  • Extend financing options for higher cost services to accelerate reimbursements
  • Eliminates surprise bills that lead to patient dissatisfaction and collections

As a truly end-to-end solution, Myndshft doesn’t stop with patient financial responsibility calculation. We automatically determine prior authorization requirements, pre-screen submissions for errors and medical necessity and then submit directly to payers via their preferred method. (But that’s a blog for another time.) 

Bottom line: Your patients want to know costs up front. When they do, you reap the benefits too. 

Find out how Myndshft can help you get there.