Early estimation informs and engages patients

Estimator starts financial relationship on the right foot.

By Melanie Wolkoff Wachsman

No matter how big or small your pract ice is, most pract ice managers will agree that collecting from patients is one of the biggest challenges that hospitals and practices face. ZirMed, Inc., a sof tware-as-a-service (SaaS) revenue cycle management solutions provider, has been tasked with taking the challenge out of collecting. The Louisville-based company responded with the ZirMed Patient Estimation, a web-based solution that enables provider organizations to accurately determine a patient’s financial responsibility prior to providing service or care.

Medical News sat down with Nate Davis, product manager at ZirMed to find out how this software will enable providers to get paid faster and more accurately, while reducing days in A/R and ultimately improving cash flow, and why it’s critical to a practice or
hospital’s success.

Medical News: What was the impetus behind creating the ZirMed Patient Estimation?
Nate Davis: A recent TransUnion report released in June 2013 found that the average patient out-of-pocket cost for healthcare has grown by almost 22 percent this year alone. In an era where patient financial responsibility is expected to continue to grow rapidly as a percentage of overall provider revenue, it is increasingly critical for healthcare providers to collect patient payments both efficiently and effectively. It is also crucial that they understand the huge impact that activities related to patient payment (such as collections) can have on patient satisfaction, patient engagement and outcomes.

The healthcare industry has come a long way in transforming the dialogue between doctors and patients so that patients feel engaged in their own care while understanding their options and expected outcomes. Transparency, flexibility and customer service have traditionally been very sparse in financial interactions with patients, and yet these things are critical to creating a positive overall experience.

When provides communicate proactively with patients about the cost of care and offer them flexibility and support with payment plans, it leads to a more meaningful overall engagement and ultimately improves outcomes and satisfaction.

MN: How does the ZirMed Patient Estimation work?
ND: ZirMed Patient Estimation analyzes past data, drawing from what payers have historically paid on claims so that estimates are based on real numbers, and requires no contract loading, making it a cost-effective and highly accurate solution. The solution gives any provider the ability to estimate patient financial responsibility before rendering services.

A patient’s demographic information, insurance information, encounter information, and procedure information are entered into Patient Estimation, and the patient’s benefit information is retrieved. Staff can then review the details, including the charge amount, allowed amount, co-pay, co-insurance, patient responsibility, and insurance responsibility before proceeding to create the estimate.

The generated summary can be printed and provided to the patient, and if that provider also has ZirMed ZPay, staff can collect payment for the full estimated patient responsibility or set up a payment plan with the patient immediately.

MN: How does ZirMed Patient Estimation differ from other available Estimation Solutions?
ND: All of ZirMed’s solutions are software-as-a-service (Saas) solutions, so providers can be up and running in days as there is no hardware or software to install. Implementation includes uploading past remit data, which takes about 48 hours and begins before implementation. With ZirMed, no specialized training or expensive contract management system is required.

Other patient estimation solutions require providers to load in all of their payer contract information and constantly keep that information up to date, which is a time consuming and more expensive process.

Because ZirMed analyzes what payers have historically paid each provider for each kind of patient, plan, diagnosis and procedure combination to determine what the estimated patient responsibility will be, it requires no contract loading and is typically more accurate.

ZirMed patient estimation is designed to fit a provider organization’s workflow, and it can be easily implemented by back office billing or patient-facing staff. Anyone with an internet-connected computer can run a new or view an existing estimate. Staff can verify eligibility with hundreds of payers immediately using a real-time, web-based portal. Our cloud-based system enables anyone in a provider’s office to run an estimate in only a few clicks.

MN: Why is patient estimation a critical best practice?
ND: As a result of the Affordable Care Act, 20 million newly-insured patients will enter the healthcare system by 2014, with 80 percent deemed at “high risk” for non-payment. Hospitals are incurring $49 billion of medical bad debt annually as a result of servicing patients without health insurance. Providing accurate patient responsibility estimates at or before the time of care improves revenue performance by clearly communicating patient responsibility, so that the full or partial amount owed can be collected at or before the time of care.

By providing a summary of the estimate to the patient they can understand precisely how much they owe and why— which greatly enhances satisfaction. Early estimation of patient financial responsibility is the best opportunity to help patients feel informed and engaged in the financial process of their care. Estimating a patient’s financial responsibility means determining what a patient will owe, and communicating the estimate at or before the time of service. This first step gets the financial side of the relationship off on the right foot, ideally setting a tone of accuracy, transparency and proactivity.

It is critical to helping patients understand and feel good about the financial and clinical expectations of their care. As providers look to become more flexible and transparent in the billing process, they must clearly and sensitively communicate an accurate upfront estimate to the patient prior to service.