“Experian Well being helped us meet the compliance of the Value Transparency Rule. With out it, we’d have been topic to giant fines.”
— Marianna Ross, Supervisor of Buyer Providers and Monetary Counseling at UTMC
Problem
Earlier than 2020, UTMC, a number one Stage 1 Trauma Middle that serves sufferers throughout three states, relied on a guide, time-consuming affected person estimate course of. However when the Facilities for Medicare & Medicaid Providers (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 costs and CPT codes utilizing historic claims in an inner reporting system. With out a digital system in place, the staff was struggling to do its job effectively, and sufferers weren’t at all times in a position to get data required by the ruling.
To keep away from compliance penalties, UTMC wanted a streamlined estimate course of with higher instruments and the mandatory integration to offer clear, upfront worth estimates. The brand new course of additionally wanted to be dependable underneath a possible CMS audit and easy for workers to make use of whereas permitting for future scalability.
Resolution
To make sure the hospital might sustain with changing price transparency regulations, UTMC partnered with Experian Well being and applied Patient Estimates. As an alternative of tedious guide 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 information.
Patient Estimates gave employees 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 might simply show its compliance with the brand new Hospital Price Transparency Rule.
And after a profitable implementation and fulfilling all 2021 Hospital Value Transparency Rule mandates, UTMC continued working with Experian Well being to develop a strong and unified affected person fee 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 help 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 throughout the yr. With Patient Estimates, Self-Service Patient Estimates, PaymentSafe and Patient Financial Advisor working collectively, the staff didn’t simply meet the objective — they exceeded it by 42.77%.
Final result
With a completely built-in system now in place, employees and sufferers each get entry to correct estimated value breakdowns—and estimates are despatched a couple of days sooner than UTMC’s earlier course of. With strong value breakdowns and a number of fee choices, employees 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 keeping 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 huge ends in compliance and the variety of estimates it points.
Ross encourages different hospitals going by comparable transitions to first spend money on their contract information—and that features discovering the appropriate know-how companions. She notes that partnering with Experian Well being was essential to the success of UTMC’s new affected person fee system. “Experian Well being advanced with us as our wants progressed and altered to make sure we obtained essentially the most from the merchandise.” Ross additionally reminds organizations who’re making the swap to teach sufferers: “This can be 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 may also help healthcare organizations keep compliant with present rules and assist sufferers higher perceive their prices.
