Incorporating Price Transparency With Pre-Visit Billing Practices

As healthcare becomes more consumer-driven, price transparency needs to be the norm. Find out how pre-visit billing can benefit your practice.

Medical costs have become a never-ending maze of surprises and confusion over the past decade as insurance plans have shifted more financial responsibility onto patients' shoulders through high deductibles and copays. For many patients, they are now responsible for a much larger financial chunk of their care. For these patients, they feel practices and doctors are leaving them completely in the dark about what that care will cost until weeks or months later when a dispiriting and confusing medical bill shows up. This lack of transparency and surprise billing has put a hole in patient trust and satisfaction. It is at this time, however, that the importance of pre-visit billing comes into play.

Change is now underway. In 2021, a federal Hospital Price Transparency rule was instated that requires hospitals to provide clear pricing on their services and procedures online. This lets patients compare costs across hospitals to find the best value. Now patients need more doctors and clinics to follow suit by integrating price transparency into upfront billing conversations. Before any non-emergency visit, patients should get a cost estimate based on their insurance to avoid surprise bills down the road.

This “pre-visit billing” gives patients the power to budget for medical expenses and choose affordable options. The healthcare industry shifted financial responsibility to patients without giving them the tools to be empowered consumers. Price transparency finally levels the playing field so patients can make informed decisions and find high-quality care at fair prices. Providers who embrace transparency will earn patient trust and loyalty by putting patients' needs first.

The Benefits of Price Transparency in Healthcare

According to a study by the New York Department of Financial Services, the average out-of-network emergency bill was about $7,000. Insurers typically only cover half, leaving patients to cover almost $4,000 out-of-pocket. Another study found the cost of specialist physician care has increased by around 3.4 percent, or $40 billion, largely due to out-of-network billing surprises.

So, what can providers do to rebuild loyalty while staying financially sound? Follow the new federal price transparency rule. 

Empowering Patients as Consumers

Access to cost estimates enables patients to budget for care, compare prices across providers, and make cost-effective choices. This is invaluable as patients pay thousands more in out-of-pocket costs. Price transparency also builds patient engagement in their care.

Building Patient Trust and Satisfaction

44% of respondents in one survey reported avoiding healthcare services because they were unsure of the costs. Transparent, upfront pricing avoids bill shock down the road. This also fosters patient trust and reduces dissatisfaction with costly medical bills. 

Reducing Surprise Billing and Disputes

Unexpected medical bills are a leading cause of patient frustration. Price transparency and pre-visit billing practices limit surprises around patient responsibility by clarifying financial obligations ahead of time. This also reduces billing disputes and improves collections.

Meeting Regulatory Requirements

Price transparency regulations continue expanding at the federal and state levels. These regulations include compliance orders that require making provider-specific cost data publicly available to patients. 

Challenges in Achieving Price Transparency

Pre-visit billing strategies - Woman holding a credit card while paying medical bills using a smartphone.

While critical, true price transparency has proven difficult to attain in healthcare due to several factors:

Complexities in Healthcare Pricing

Healthcare pricing is highly complex and varying—incorporating facility fees, provider charges, insurer rates, diagnostics, and more. This makes it challenging to produce accurate price quotes. Pricing also differs based on location and providers. 

Data Availability and Accuracy

The availability and accuracy of pricing data are crucial for effective price transparency. However, obtaining accurate and up-to-date pricing information can be challenging in and of itself. Inconsistent data collection, poor integration of pricing systems, as well as the lack of standards around cost data prevent easy access to meaningful pricing estimates. 

Patient Understanding and Engagement

Despite demanding price transparency, some patients do not use cost data when available. Even when pricing information is available and utilized, some patients still may not fully understand the information. This stems from the type of data provided, as well as factors related to seeking care. This issue stresses the need for effective communication strategies. Improved patient education and support around using pricing data is needed.

Strategies for Incorporating Price Transparency With Pre-Visit Billing Practices

Sticker shock in the exam room is becoming all too common — patients arrive for a doctor's visit and then are mailed an expensive bill they didn't see coming. To fight surprise medical bills and empower patients, more healthcare facilities are combining pre-visit billing with price transparency tools.

Here are just a few strategies that can be used to incorporate price transparency into pre-service financial conversations seamlessly:

Verifying Insurance Coverage and Benefits in Advance

Obtaining patient insurance information is foundational to generating pre-visit billing estimates based on expected coverage and out-of-pocket liability. This includes benefit details, network status, deductibles, copays, as well as coinsurance. Healthcare providers should verify a patient's insurance coverage and benefits before their visit. This step also allows providers to share accurate cost estimates based on the patient's specific insurance plan.

Providing Cost Estimates for Services

Providers should offer Good Faith cost estimates for their services before the visit. These estimates should include potential out-of-pocket costs, which will help patients understand what they will be responsible for. Providers should use real-time data to create a personalized price quote for the scheduled services based on the patient's benefits and provider contracts. 

Offering Payment Options and Financial Counseling

Providers can support patients by offering a diverse set of payment options and providing financial counseling. Allow patients to pay pre-visit balances easily through integrated billing and payment processing capabilities. Offer payment plans to help ease the burden.

Leveraging Technology for Transparency

Technology also plays a crucial role in enhancing price transparency. Certain tools are not just about automation; they're about providing clarity, promoting understanding, and fostering a more patient-centric approach to healthcare finance. With the right technology, healthcare providers can navigate the complexity of billing a little easier, hopefully leading to improved patient engagement, satisfaction, and trust.

Training Staff on Price Transparency Communication

Effective communication in healthcare is critical, especially when it comes to discussing price information. It's not just about relaying numbers; it's about providing a form of clarity and ensuring each patient understands. Training your staff will equip them with the skills to convey clear and accurate pricing information to patients. It's about turning complicated financial data into understandable information, turning uncertainty into certainty, and improving the patient experience. 

Overcoming Challenges

Providing pre-visit billing information - Female doctor speaking with her patient over the phone.

Achieving true price transparency takes work – there's no quick fix. It requires investing time and resources to tackle all the challenges head-on. But this effort pays off greatly when it comes to patient satisfaction and financial stability. By making pre-visit billing clarity a priority across healthcare organizations, providers can overcome several challenges.

Addressing Data Accuracy and Availability Issues

  • Implement data management practices to keep contracted rates, fee schedules, and claims information up-to-date.
  • Implement a daily process for billing staff to flag claims that are paid at unexpected rates for investigation.
  • Centralize payer details and cost histories in integrated billing systems accessible to front-end staff.

Educating and Engaging Patients Effectively

  • Summarize estimates in layman's terms like “amount insurance is expected to cover” and “your typical out-of-pocket cost.”
  • Use patient portals and messaging tools to increase access to estimates.
  • Follow up with patients to determine their level of understanding and address questions.
  • Make financial counselors available to explain costs and financing options.

Compliance With Regulatory Requirements

  • Establish processes for generating and sharing legally compliant good faith estimates.
  • Develop workflows to verify active insurance coverage for accurate pre-visit estimates.
  • Stay up-to-date on changing transparency regulations and adjusting protocols when necessary.
  • Use billing technology to streamline the process of sending legal notifications of financial obligations.

Tools and Technology Solutions

There are some great tools out there that make pre-visit price transparency smooth and easy. For instance, our Pre-Visit Billing tool lets providers send patients a unique payment link to collect fees upfront – whether it's an office visit or telehealth. Patients can pay their share with just a text or email, without the hassle of formal bills down the road. This saves billing costs for practices and gives patients financial clarity. No more post-visit surprise invoices!

Patient Perspectives on Price Transparency

Research has shown that pricing information increases patient satisfaction and loyalty. Research has also shown that many patients are not satisfied with their financial experiences. This dissatisfaction stems not only from billing processes but from a lack of financial transparency earlier in the care journey.

Patients want and need to understand the financial implications of their care options before making treatment decisions. They appreciate having open conversations with providers that cover both clinical and financial considerations when weighing care alternatives. For example, comparing the costs and benefits of a costly surgery versus trying a less invasive option first that may achieve similar results over a longer period.

More providers need to discuss pricing and insurance coverage details upfront, rather than leaving patients confused until they receive a bill several weeks later. This approach allows patients to be a driver and not a passenger in their care journey. 

The Future is Transparent with BillFlash Pre-Visit Billing

Female doctor using a tablet device to explain a senior woman’s medical bill.

Pre-visit billing presents the perfect opportunity to integrate meaningful price transparency into patient financial interactions through upfront estimates that empower informed decisions. Transparency delivers advantages for both patients and providers—ensuring understanding of costs for patients while allowing efficient payment collection for providers. A true win-win!

As healthcare becomes more consumer-driven, price transparency needs to be the norm. We know change takes effort, but the tools exist to make transparency painless for providers and patients. BillFlash Pre-Visit Billing makes collecting payments a breeze, seamlessly integrating with more than 100 EHR and billing systems. 

Now is the time to embrace price transparency through pre-visit billing and estimates. You'll gain happy patients who feel empowered and respected. And that's what the best care is all about. Schedule a demo with us today and let pre-visit transparency work for your practice!

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