Waystar explores how innovative tech is bringing needed transparency and consumerization to a patient financial experience marked by surprise medical bills and growing out-of-pocket costs, while also helping providers improve key administrative processes.
The US healthcare system’s lack of price transparency is perhaps the single biggest issue plaguing the patient financial experience. Across care settings, patients receive treatment with little sense of out-of-pocket costs and what will ultimately be covered by their insurance. And when bills do come, they’re often higher than expected, difficult to understand and unpredictably timed.
Surprise billing on the rise
This lack of financial clarity, paired with the fact that patients have to shoulder a higher percentage of care costs under high deductible plans, often leads to surprise medical bills following inpatient hospital visits, emergency care, lab tests or other care episodes.
According to a 2019 JAMA study, there’s a growing possibility patients will be billed by an out-of-network provider even when they go to an in-network hospital for care. And, these unanticipated bills are only getting more expensive.i In a survey conducted last fall by national consumer group Families USA, nearly half of respondents (or someone in their family) had received a surprise out-of-network bill. More than 75% of those people were charged at least $501—no small sum for many households.ii
The burden of confusing pricing and surprise bills isn’t just felt by patients. As we shift toward value-based reimbursement models and patients take on increased responsibility for their healthcare costs, providers are overhauling their self-pay collection strategies. After all, it’s in providers’ best interest financially to make sure patients receive a clear, convenient consumer experience. What does that look like? Clear price estimates ahead of care, timely billing cycles, flexible, digital-friendly payment options and more.
How to tackle price transparency
Fixing this surprise billing problem has received widespread bipartisan support. While new legislation is crucial to fixing this problem, better revenue cycle management technology is also critical. Providers of all kinds need reliable tools that give patients a better sense of out-of-pocket expenses—solutions that bring clarity and speed to payment processes so patients can take a more proactive, informed role in their care. With the help of AI and other disruptive technologies, billing is becoming a more consumer-centric experience.
One such tool is an online price estimator we implemented at Georgia-based University Health Care System. Originally developed by our most recently acquired company, this tailored estimation tool allows patients to easily generate an accurate approximation of out-of-pocket costs for a given service. All they have to do is access the University website and provide some basic information about their coverage, the type of procedure they need and their preferred facility.
The upside for providers
University has found patients are more willing to pay at the point of service when they have a clear sense of what they owe out-of-pocket. In fact, they’ve seen upfront payments improve by 50% in just a few years.iii What’s more, their billing office has been able to limit manual workflows and gain better insight into how much patient-pay revenue they can count on. For non-profit facilities that need to meet certain charity-care requirements, tools like this can help significantly reduce bad debt.
Opaque pricing and billing practices prevent patients from making informed financial decisions and can result in crippling unforeseen bills. Fortunately, innovative solutions powered by AI and robotic process automation are already being deployed to streamline prior authorizations, generate cost estimates and simplify the financial screening process. Explore some of our most popular solutions here.
But, innovative tech is just one piece of the price transparency puzzle. Payers and health IT vendors must strive for better interoperability. Policymakers must set billing rules that serve both patients and providers. And, providers must strive to deliver the same level of clarity and convenience patients have come to expect from other consumer-facing businesses.
iAssessment of Out-of-Network Billing for Privately Insured Patients Receiving Care in In-Network Hospitals, JAMA Internal Medicine, August 2019
iiSurprise Medical Bills National Survey, Families USA, October 2019
iiiProviders innovated patient engagement and experience in 2019, Healthcare IT News, December 2019
Waystar delivers cloud-based technology that simplifies and unifies the healthcare revenue cycle—and brings more transparency to the patient experience.