Price Transparency and Compliant Hardship Discounts Improve Revenue Collection

Ambulatory surgery centers (ASCs) are under constant pressure to operate at lower costs than hospitals. Despite staffing shortages, they’re expected to provide a superb patient experience in an increasingly price-sensitive environment. Growing numbers of uninsured, under-insured, and high-deductible patients continue to challenge financial performance. Fortunately, there are ways to improve the patient’s financial experience while also improving self-pay conversion.

All ASCs are accountable to the Centers for Medicare & Medicaid Services (CMS) requirements for price transparency. In addition, many ASCs offer discounts for hardship and prompt payment of patient-responsible balances. Implementing presumptive charitable screening at the front end of the patient encounter is an effective way to improve patient engagement and ensure that accurate, compliant pricing is provided. Furthermore, engaging patients financially at the front end ultimately drives higher reimbursement with less effort and lower administrative costs. 

Using real-time presumptive charitable screening technology at the beginning of a patient encounter increases the likelihood they’ll pay their portion. “A patient who is an active participant in the financial aspect of their healthcare journey knows in advance what will be covered by their insurance and what portion of the bill will be their responsibility. They’re empowered to make informed decisions,” says Juli Smith, Director at ZOLL Data Systems. “If there is a hardship, ASCs with charitable discount programs can offer a payment plan prior to providing service, reducing the risk that the patient will defer medical care for financial reasons.” 

Before offering financial hardship or prompt-pay discounts, however, ASCs are advised to ensure that they have a plan in place to do so compliantly. Failure to do so risks running afoul of the Federal Anti-kickback Statute and OIG advisory opinions. Fortunately, knowing the law and establishing (and publishing) a policy and procedure that treats all patients equally will address compliance issues and protect ASC executives from criminal charges or lawsuits.

Financial Screening Can Transform Collection Rates 

There is a strong business rationale to support presumptive charitable screening. “Industry research shows that more than 91% of medical expenses from uninsured patients and 56% of patients with out-of-pocket medical expenses never get paid,” says Smith. “Offering competitive, patient-centric financial care improves the odds of receiving optimum reimbursement.”

James Zadoorian, Ph.D., Managing Principal of ARxChange, describes the rationale this way: “Patients do not pay when financial assistance is insufficient, either because they can’t or because they elect not to. However, if financial assistance is targeted precisely to patients’ circumstances, they are more likely to pay in full, and their payment levels will help providers achieve the highest possible revenue.”

Yet, the staffing realities of most ASCs make some hesitant to take on a greater administrative burden to implement a new program. That’s where automated AR optimization and patient eligibility tools come in. Automated presumptive charitable screening tools lift the burden of manual screening from the shoulders of administrative and billing staff. Best-in-class technology streamlines and accelerates workflows and returns accurate, reliable data in near-real time.

Innovative ASCs are using this information at the beginning of the patient encounter to provide price transparency, to identify and enroll patients eligible for Medicaid, and to presumptively qualify them for available financial assistance — quickly and cost effectively. The data enables them to know each patient financially and make informed decisions about hardship discounts, customized payment plans, and more.

High-quality demographic and eligibility data can be combined with other information to develop patient-centric payment programs. For example, “We’re using ZOLL® AR Boost® data in our partnership with a major credit card company to enable providers to engage consumers based on their unique economic circumstances. Doing so removes access barriers and increases financial wellness. It ties price transparency to what people can realistically afford,” said Zadoorian.

Three Steps Improve Self-pay Conversion

Complying with price transparency rules and offering customized patient financial care in line with industry and government regulations involves three steps:

Step 1: Develop and publish a clear, understandable patient discount and financial assistance policy, and apply it consistently to all patients.

Step 2: Take advantage of best-in-class presumptive charitable screening technology to find more data faster. Tools for demographic enhancement, insurance verification and discovery, deductible management, and self-pay analysis quickly and accurately determine the patient’s financial situation, eligibility for charitable assistance or retroactive Medicaid, propensity to pay, and more without adding to staff workload. 

Step 3: Based on the financial profile, develop a compliant, patient-centric package, including one or more of the following:

  • Transparent pricing based on the patient’s financial situation
  • A financial hardship discount (per your published policy)
  • Filing a claim on primary, secondary, and tertiary coverage
  • Coordination of government assistance (retroactive Medicaid)
  • A prompt-pay discount
  • A payment plan customized to the patient’s financial situation

Early Patient Engagement Supports Healthy Financial Performance

Presumptive charitable screening tools, such as those in the ZOLL AR Boost solution suite, are an important enabler for meeting ASC price transparency and charitable discounting objectives. Treating the patient as an individual, both medically and financially, can have transformational effects. The patient receives the care they need, free from uncertainty related to their financial obligation. At the same time, the ASC takes greater control of their revenue cycle, optimizing reimbursement and reducing the administrative burden placed on their staff.

This article is a collaborative effort with ZOLL Data Systems.

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