1. Delivering Accurate Patient Estimates
Presentation Prepared for AHHAM Conference September 22, 2016 Jamie Hurst—Financial Educator Sharon Scruggs, Manager Revenue Cycle

2. Estimation of Co-Pay/Deductibles History
One of the key elements was that one department head was the Manager of the Contracting with Payers, Self-Pay Collections and Charge Description Master.
Manager had access to all negotiated payer plans and in 2007 met monthly with the Insurance Brokers, Large Employer Groups in Fairfield and surrounding counties and with the Fairfield Chamber of Commerce.
We collaborated with these groups and a Community Resource group to develop a communication of the cost for scheduled procedures at FMC.
Bullet #1 – sometimes we just didn’t have their insurance information but when we would make contact with them they would advise us of their insurance. Sometimes they truly was uninsured.

3. Tools Available
We developed grids based on the procedure with CPT codes, the cost of the procedure, the payer contract and the Physician(s)
Central Scheduling provided a Financial Representative Team access to all scheduled procedures.
Team utilized Payer sites to identify deductibles and confirm co-pays.
Merged process of data elements into a personalized letter for a dedicated Financial Representative.
Fast forward about 9 years – Focusing on the insured population
Bullet Two: We researched best practice and found it necessary to include all payers, not just the uninsured. This turned out focus on to the patients with insurance

4. Point of Service: The Manual Process
We developed the point of service letter that was sent to the patient letting them know when their procedure was, the cost of their procedure, what their out of pocket cost would be as well as the discount amount we offer if they pay at or prior to service.
We provided a dedicated Financial Representative by Service Line.
Bullet One: The grids enhanced the ease of working the point of service letters manually

5. I would like to introduce myself as your personal Financial Representative and wish to thank you for choosing Fairfield Medical Center for your healthcare needs. We are committed to providing the highest level of services, which includes navigating through the financial process. We received information for your procedure scheduled on «DOS». As of today, your anticipated financial responsibility defined by your insurance carrier, «Ins», or your Self-Pay status is calculated below: Scheduled Procedure: «Procedure» Anticipated Cost of Procedure: «Anticipated_Cost» Co-Pay «CoPay» Deductible «Deductible» Co-Insurance «Co_Ins» Your Anticipated Financial Responsibility: «Financial_Resp» *20% Savings Opportunity: «Savings» Total Including Discounted Savings: «Due_after_Disc» The savings opportunity is applied if *paid on or before the date of service. It is important that you recognize the amount of savings could change based on how your insurance company processes your claims. If the anticipated responsibility should change, your savings amount will be recalculated and reviewed for additional saving or a refund. I am available to help you navigate through the multiple options available which include: Financial assistance on amount owed 0% Interest loan for the first 12 months Assistance with applying for Medicaid and/or other resources. Please contact me at If I am not available, a Financial Representative can assist you by calling
Our original sample point of service letter

6. Point of Service: The Advantages of a Manual Process
The majority of our patients were very pleased to see what they would be facing financially – Patient Satisfaction
Financial Representatives became very knowledgeable of the cost of service lines due to the research to quote.
Payer or employer changes were identified quicker relating to co-pay or deductibles.
Increased our point of service collections
Collections went from an average $200,000 a month to an average of $1,044, combined (uninsured and insured) - Sustainability
No cost for software or monthly support fees.
Bullet Two: $200,00 is based on prior to 2009 and $1,044, is based on 2011 data

7. Point of Service: The Disadvantage of a Manual Process
Time consuming for staff
Not able to keep up with the add-ons to the schedule or changes to procedures
Not able to do real time quotes by Registration Staff or others not trained in researching spreadsheets
Manual process of keep up spreadsheets did not link directly into our Contract System
Multiple Systems look ups to view letter

8. Point of Service: Moving from Manual to Electronic - The Benefits
We were really good with the manual process, but needed to be more efficient with notifying all scheduled procedures, allow the estimation of cost to be provided at all access points—providing transparency and meeting regulatory requirements.
After 7 years of our manual process we moved to an electronic format.

9. Estimator: Generates Patients Out of Pocket Expenses According to:
Multiple electronic search tools are used to assign the appropriate DRG or CPT codes from the Charge Master or DRG data to generate an estimate cost of procedure according to scheduled procedure
Payer contracts are linked to define contractual adjustments and current patient benefit information to generate a printable estimate

10. Key Requirements As We Moved Forward
Maintain accuracy
Maintain high customer satisfaction
Maintain high level of sustainability
Maintain an ease of daily operation process of providing the cost of procedure to our patients
Enhance transparency
Regulation alignment – identifying financial assistance in real time

11. Current Key Performance Indicators
Current A/R Days: 42.3 Days
Top Quartile: 45.0 Based on HBI
Current Bad Debt: 1.2%
Top Quartile: 1.5% Based on HBI
Point of Service Collections As % of Net Revenue: 1.55%
Top Quartile: 0.7% Based on HBI

12. Questions?