Challenge: Lack of estimates left patients guessing and putting revenue at risk
Many hospitals view patient estimates as just another compliance checkbox. However, regulatory scrutiny by the Centers for Medicare & Medicaid Services (CMS) is intensifying, so healthcare providers cannot afford to “hope it’s right.” Regulatory fines and reputational damage are not the only risks. Inaccurate or difficult-to-access estimates can erode patient confidence, reduce pre-service collections, and leave staff drowning in manual work.
“Without a clear understanding of your financial responsibility beforehand, even a successful surgery can be overshadowed by the stress of an unexpected bill. By providing accurate estimates up front, we help ensure that financial concerns don’t interfere with your recovery.”
Morgan Jones, Patient Services Manager, Avita Health System
Avita Health System wanted to help its patients better understand their financial obligations, improve financial transparency, and reduce billing surprises. However, they lacked the tools to provide pre-service cost estimates. There were also gaps in data quality, making it difficult to determine how much patients likely owed. Patients were frustrated when their bills arrived and Avita’s pre-service charges were inconsistent, with an average of just 1.5% charged as estimated.
Avita needed a partner, a more consistent process, and better data to generate accurate patient estimates.
Solution: Accurate Estimates and Training to Increase Staff Confidence
Avita partnered with Experian Health, a trusted partner, to implement Patient estimates. This solution uses Chargemaster data, payer contracts, claims history, and real-time eligibility data to calculate accurate estimates that staff can explain with confidence. Avita also integrated Self-Service Patient Estimates into your existing workflow, to offer more than 300 purchasable services.
“Patient estimates breaks down costs to the benefit level, allowing our staff to clearly see what is covered by coinsurance or deductible and how much is left. “They can confidently explain the estimate to patients in an easy-to-understand way.”
Morgan Jones, Patient Services Manager, Avita Health System
Direct access to Experian Health’s support team (and their proactive responsiveness) also helped Avita make continuous improvements. When payer rules changed earlier in the year, the Experian Health team stepped in to adjust the logic and resolve accuracy issues.
Avita also implemented Experian Health technology. Energy reports tool, which allows them to review hospital-level performance, reconcile accounts and investigate coding discrepancies.
“We periodically review all of that data to reconcile it and see where the underlying issues are so we can further improve our accuracy.”
Nathan Strome, Director of Revenue Integrity, Avita Health System
But Avita saw its biggest benefits by training staff on best practices for pre-service collections and its point-of-service collections. With additional support and training, Avita staff were able to translate estimates into secure financial conversations and payment requests.
Results
| Results of patient estimates: |
| – 47% increase in pre-service charges made |
| – A 169% increase was achieved in cash collections at service points. |
| – 95% of scheduled patients now receive a quote prior to service. |
| – 93% accuracy is achieved when estimating what patients owe |
Since the implementation of Experian Health Patient estimatesAvita now provides 95% of scheduled patients and 80% of walk-in patients with a clear estimate before care, with 93% accuracy. With fewer billing surprises, patients have a better experience, and Avita’s pre-service collections increased nearly 50%, from $2.9 million to $4.28 million over a two-year period. Staff are also collecting more of the patient liability early, with a minimum of 11% charged up front compared to 1.5% before training.
“We weren’t willing to sacrifice accuracy.”
Angela Murphy, Senior Revenue Cycle Coordinator, Avita Health System
But for Avita, prioritizing data accuracy remains non-negotiable, especially since CMS oversight leaves little room for error. “If the estimates are not accurate, no amount of training and programming will make a difference,” says Murphy. “Don’t assume your build is perfect. Audit your work and don’t hesitate to request changes when necessary.”
Find out how Experian Health works price transparency solutions Help healthcare organizations comply with current regulations and help patients better understand their costs.