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Revenue Cycle Time Line: Estimation This article has links to allow easy access time line content from
Scheduling to Bad Debt Recovery. Use
this information as a starting point for planning, SWAT Analysis, or to
review policies and procedures for gaps.
Create a time line for your facility to assure all participants share
the same expectations. Goals: ·
Provide an estimate for the out-of-pocket amount due
from patients before services begin ·
Meet consumer expectations for pricing “transparency” ·
Reduce cost of collecting patient liabilities Activities and Considerations: Self Pay balance
estimates are required for transparency initiatives. Patients have a “right” to know what they
should expect to pay if they receive care from a specific facility. A Registration
Associate may need to generate an estimate when a patient is: ·
Considering whether to have services at a facility ·
Scheduling services at a facility ·
Arriving for services ·
Completing services Tools must be
available to guide the Associate through the estimation process. For simple
diagnostic services, pricing should be available from a service price
list. For more complex services, such
as surgical procedures, estimated charges should be calculated from history,
using similar cases, preferably physician-specific. Selection of procedures should be available
by CPT Code, CPT Description, and “drill down” to common procedure names. Even after an
estimate is generated, patient balances after insurance are difficult to
calculate because: ·
Managed care agreements have different allowable
amounts (approved charge rate for the procedure) ·
Employers and plans have different patient liability
options; Deductible and co-payment
amounts must be calculated from up-to-date information from the verification
process) (link) The estimate of
total charges, insurance coverage and residual self pay portion generated
should have the option to print be saved for retrieval upon the patient’s
arrival. On the printed
document: ·
Hospital payment options should be displayed ·
An estimate “disclaimer” should print at the bottom of
the page.
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