Published: Dec 21, 2022
8 minute read
Workflow Automation

Patient Cost Estimate Software: Why You Should Adopt Now

Rex H.
Rex H.
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Modern healthcare consumers want to avoid surprise medical costs and make better healthcare decisions. They also want to compare and contrast the best healthcare providers as they do for other services.

That's where patient cost estimate software comes in. Sleek, streamlined, and easy to use, patient cost estimate software gives patients transparency into service and item costs. Healthcare providers can also use patient cost estimate platforms to create user-centric experiences by automatically generating and sending cost estimates ahead of time, enabling digital payments and collection from estimates, real-time notifications, and much more.


What Is Patient Cost Estimate Software?

Patient cost estimate software improves price transparency by providing patients with accurate out-of-pocket cost estimates. Many healthcare providers and practitioners use patient cost estimation software to increase collections and improve the consumer experience. Depending on the vendor, patient cost estimate software may also:

  • Let you create and auto-send cost estimates through letter, text, and email
  • Allow patients to pay upfront directly from their estimate
  • Give healthcare staff real-time notifications

Why Current Developments in Healthcare Necessitate Patient Estimation Solutions

Current healthcare developments have made patient price estimate software necessary for healthcare providers:

  • Many consumers are receiving surprise medical bills. As such, they want to know how much they have to pay upfront. Specifically, a Trends in Healthcare Payments Annual Report has revealed that 87% of consumers were surprised by a medical bill, and 90% of healthcare consumers want to know payment responsibility upfront.
  • As of January 1, 2022, the No Surprises Act (NoSA) requires healthcare providers and insurance companies to issue and send good faith estimates (GFEs) to self-paying and uninsured patients. GFEs are notifications that outline self-paying or uninsured consumers' expected changes for a scheduled or requested item or service. Each GFE should include primary items and services as well as the items and services reasonably expected to be provided. This also includes if the consumer will receive the items and services from another provider or facility.
  • High-deductible health plans are also on the rise. According to a 2022 ValuePenguin report, 52.9% of American workers with private insurance enrolled in HDHPs as of 2020, up from 39.4% in 2015.
  • Premium contributions and deductibles have also been increasing in employer health plans and amount to 11.6% of US median household income, up from 9.1% in the last 10 years.
  • Additionally, 55% of patients’ financial responsibilities are never recovered by providers. In other words, many patients have to pay out of pocket to receive the healthcare they deserve.
  • Finally, patient payments account for nearly 40% of the total revenue of the average practice. Therefore, it's important to let patients know how much they must pay beforehand. Otherwise, they may give you negative ratings for failing to be transparent.

These statistics and trends demonstrate that patient responsibility is increasing and that self-pay will become a growing part of practices' revenue. However, practices will also lose more revenue due to surprise medical bills since patients' financial responsibilities are increasing.

Accordingly, patient estimates are more necessary than ever before, especially since they are now required by law for self-paying and uninsured patients. The right patient estimate software can help you eliminate surprise bills, generate and send cost estimates, and make it easier for patients to pay online anywhere, anytime, and on any device.

Typical Functionality of Patient Estimation Tools

Patient estimation solutions' features vary depending on the vendor. However, most provide the following functionalities:

Automatically Generate and Send Patient Cost Estimates Ahead of Service

Patient estimation software can automatically create and send patient cost estimates before service by mail, email, and text. This allows you to meet NoSA's strict timeframes for sending GFEs to uninsured and self-paying individuals.

Enable Upfront Digital Payments and Collection From Estimates

Patients can digitally pay and make payment plan elections directly from their estimates.

Integration with Electronic Health Record (EHR) and Practice Management Software

Managing and organizing patient records can be difficult, especially if you run a large practice with thousands of patients. Luckily, most patient estimation tools integrate with your practice's electronic health record (EHR) and practice management software. As a result, you can manage workflows, GFEs, patient files, and administrative tasks with just a few clicks of your mouse.

Real-Time Notifications

Patient estimate platforms can also deploy real-time notifications for cost estimates. You can use these alerts to notify patients about their out-of-pocket costs immediately, so they can determine whether your service fits their budget.

Eligibility and Insurance Verification

Lastly, patient estimate software can verify patients' insurance eligibility by instantly revealing patients' insurance statuses. If a patient is revealed to be self-paying or uninsured, you can immediately use your patient estimation tool to generate and send a GFE on the spot. The patient can then decide whether they want to proceed or choose another provider.

How Patient Cost Estimation Software Benefits Your Organization

Besides offering powerful functionalities, patient cost estimation software can provide many benefits for your organization, including the ability to increase upfront revenue collected, reduce bad debt, and improve the patient experience. It can also help you stand out in your local market, comply with the NoSA, and improve staff productivity.

Increase Upfront Revenue Collected

First, patient cost estimation software can increase upfront revenue collected.

In a January 2022 PYMNTS report, 89% of patients surveyed believe that it's easy to pay upfront when they know their bill beforehand. As a result, Florida's Health First health system increased upfront collections by 27% and reached 2.7% of net revenue in point-of-service collections compared to the industry benchmark of 0.7% after moving to a 100% of patients receiving cost estimates policy.

Similarly, California-based clinical lab testing company Counsyl increased revenue collected from patients by 63% after adopting a patient cost estimation tool. The software also helped Counsyl increase its Net Promoter Score (NPS) by 4% for customer satisfaction.

Reduce Bad Debt

Let's face it: no one wants to pay for services that will put them in debt. According to "The Healthcare Conundrum,” an Experian Health and PYMNTS collaboration based on a survey of 2,483 consumers, 60% of consumers who were living paycheck-to-paycheck and had issues paying their bills canceled an appointment after receiving a cost estimate they couldn’t afford.

Fortunately, accurate cost estimate software can reduce canceled appointments by giving consumers accurate cost estimates ahead of time. That way, consumers can either decide to pay upfront or choose another provider.

In addition to helping patients make educated choices, cost estimates make it easier for providers to collect payment upfront, leading to increased cash flow. This, in turn, mitigates accounts from going into bad debt.

Improve Patient Experience

Patient cost estimate software can greatly diminish surprise bills, providing for a superior patient experience.

A reference study by Experian and PYMNTS found that patients who were not provided cost estimates ahead of time were less satisfied than patients who were provided estimates. Specifically, 78% of patients who did not receive an estimate were satisfied with their doctor, whereas 88% of patients who received an estimate said they were satisfied.

Stand Out in Your Local Market

Patient cost estimate tools are relatively new to the market. A January 2022 PYMNTS survey revealed that only 30% of patients had received a cost estimate ahead of services.

Therefore, patient cost estimate platforms can make you stand out in your local market. According to Deloitte, 60% of patients are more likely to choose a provider that is open with prices compared to local providers who are not.

Get in Compliance With the No Surprises Act and Avoid Penalties

Since January 1, 2022, the NoSA has required insurance companies and healthcare providers to send GFEs to self-paying and uninsured patients. Eventually, this requirement may expand to include insured patients.

To comply with the NoSA, you must meet stringent deadlines. Specifically, you must provide an uninsured or self-paying individual with a GFE according to the following timeframes:

  • When a primary service or item is scheduled at least 10 days before the service or item's furnishment, you must send the GFE within three days of the scheduled date
  • When a primary item or service is scheduled at least three business days before the date the item or service is scheduled to be furnished, you must send the GFE within one business day of the scheduled date
  • When an uninsured or self-pay individual requests a GFE, you must send the GFE within three business days of the requested date

You must also comply with a bevy of other requirements, including:

  • Disclosure requirements: The NoSA requires you to prominently display comprehensive, clear, and easy-to-find information about the availability of FGEs for self-paying and uninsured individuals in your office, site, and wherever scheduling and questions about medical costs happen. You must also:
  • Provide information about GFEs for self-paying and uninsured individuals when scheduling an item or service or when asked questions about medical costs
  • Consider any discussion or inquiry about potential costs as GFE requests
  • Provide information about GFE availability for self-paying or uninsured individuals in accessible formats and the language(s) spoken by the consumer(s) scheduling or considering items or services
  • Content requirements: The NoSA requires GFEs to contain specific information, including:
  • The patient's name and date of birth
  • A description of the primary item or service
  • The scheduled date of the primary item or service
  • A list of the items and services reasonably expected to be furnished for the primary item or service
  • Requirements for making changes: If you, a co-provider, or a co-facility anticipates or is told about changes to the scope of a previously-furnished GFE, you must give the self-paying or uninsured individual a new GFE within a business day. If changes in expected providers or facilities in a GFE happen less than one business day before the furnishment date, the replacement provider or facility must accept the GFE provided by the replaced provider or facility.

Meeting all of these requirements can be overwhelming, especially if you have a limited budget and staff. Luckily, a reliable patient cost estimate program can help you generate, send, and manage accurate GFEs on and ahead of time.

The discretionary period for good faith estimate compliance enforcement is expected to end on January 1, 2023, so you should adopt patient cost estimate software as soon as possible. If you don't comply with the NoSA by then, you may face monetary penalties of up to $10,000 per violation.

Improved Productivity of Staff

Last but not least, a patient cost estimate program can improve staff productivity by automating repetitive tasks and reducing the need to hire new staff. This is especially true if you're part of the 75% of providers still relying on manual collection.

Cost of Patient Cost Estimate Software Solutions

Most patient estimate tools have a cost per patient. As such, the ultimate cost of a patient cost estimate solution depends on your overall patient volume — the larger your practice, the more you will have to pay.

The structure of your software may also influence the total cost. If your chosen software is standalone, you may not have to pay as much, but if your software comes as part of a suite, you may need to pay more, depending on what features you need.

For instance, your software may cost much less if it only consists of a standalone GFE generator. However, if it's part of a larger suite that includes contract analysis and revenue cycle tools, you will probably have to pay more.

Enable and Streamline Patient Cost Estimates with MD Clarity’s Clarity Flow Software

Finding a suitable patient cost estimator can be challenging, especially if you've never used one before.

That's where MD Clarity's Clarity Flow comes in. Comprehensive and user-friendly, this patient cost estimation software helps healthcare providers comply with the NoSA by providing accurate GFEs to consumers. Specifically, you can use Clarity Flow to:

  • Create, automate, and deliver patient cost estimates and GFEs via mail, text, and email
  • Collect upfront deposits from patients directly from online estimates
  • Project accurate out-of-pocket costs

Ready to see how Clarity Flow can help you? Book a demo today.

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