“Experian Well being helped us meet the compliance of the Worth Transparency Rule. With out it, we might have been topic to massive fines.”
— Marianna Ross, Supervisor of Buyer Companies and Monetary Counseling at UTMC
Problem
Earlier than 2020, UTMC, a number one Stage 1 Trauma Heart that serves sufferers throughout three states, relied on a handbook, time-consuming affected person estimate course of. However when the Facilities for Medicare & Medicaid Companies (CMS) issued its Hospital Price Transparency Rule, UTMC’s affected person entry leaders knew their current processes couldn’t sustain with new price transparency regulations.
UTMC’s monetary counselors had been nonetheless manually extracting fees and CPT codes utilizing historic claims in an inner reporting system. With no digital system in place, the workforce was struggling to do its job effectively, and sufferers weren’t at all times capable of get data required by the ruling.
To keep away from compliance penalties, UTMC wanted a streamlined estimate course of with higher instruments and the required integration to offer clear, upfront worth estimates. The brand new course of additionally wanted to be dependable beneath a possible CMS audit and easy for workers to make use of whereas permitting for future scalability.
Answer
To make sure the hospital may sustain with changing price transparency regulations, UTMC partnered with Experian Well being and applied Patient Estimates. As an alternative of tedious handbook affected person estimate processes, Patient Estimates pulls data from the hospital’s chargemaster, payer contracts (integrating with Experian Health’s Contract Manager), claims historical past and real-time eligibility knowledge.
Patient Estimates gave workers confidence to generate correct affected person estimates, whereas sufferers felt empowered to learn a transparent, detailed estimate particular to their process. Plus, its built-in reporting meant UTMC may simply reveal its compliance with the brand new Hospital Price Transparency Rule.
And after a profitable implementation and fulfilling all 2021 Hospital Worth Transparency Rule mandates, UTMC continued working with Experian Well being to develop a sturdy and unified affected person cost technique. Along with Patient Estimates, the next Experian Well being options had been applied:
- Self-Service Patient Estimates to allow sufferers to generate both a self-pay estimate or worth estimates for providers utilizing their present insurance coverage data.
- PaymentSafe® to assist pre-service and safe point-of-service transactions.
- Patient Financial Advisor to ship textual content estimates to sufferers’ cell phones with the choice to pay.
The timing of the brand new processes couldn’t have been higher. In 2024, UTMC’s Board set a strategic objective to extend the variety of estimates delivered inside the yr. With Patient Estimates, Self-Service Patient Estimates, PaymentSafe and Patient Financial Advisor working collectively, the workforce didn’t simply meet the objective — they exceeded it by 42.77%.
Consequence
With a totally built-in system now in place, workers and sufferers each get entry to correct estimated value breakdowns—and estimates are despatched just a few days sooner than UTMC’s earlier course of. With sturdy value breakdowns and a number of cost choices, workers are empowered to have interaction in additional compassionate monetary conversations and sufferers have extra time to think about the price of care and make monetary preparations.
In line with Ross, “Estimates and funds are difficult to unravel for a lot of of our sufferers. And sufferers are scared and nervous about procedures. It’s useful to have a easy, clear breakdown of prices to assist information these conversations.”
With Experian Well being’s Patient Estimates, Self-Service Patient Estimates, PaymentSafe and Patient Financial Advisor working collectively, UTMC delivered large leads to compliance and the variety of estimates it points.
Ross encourages different hospitals going by way of related transitions to first spend money on their contract knowledge—and that features discovering the appropriate expertise companions. She notes that partnering with Experian Well being was vital to the success of UTMC’s new affected person cost system. “Experian Well being developed with us as our wants progressed and adjusted to make sure we obtained probably the most from the merchandise.” Ross additionally reminds organizations who’re making the change to teach sufferers: “It is a cultural change, not only a system change. And like all change, it takes time.”
Find out how price transparency solutions from Experian Well being might help healthcare organizations keep compliant with present rules and assist sufferers higher perceive their prices.
