CHICAGO, IL--(Marketwired - Apr 7, 2014) - According to a TransUnion Healthcare survey of more than 700 insured consumers, 75% of patients said that pre-treatment estimates of out-of-pocket costs would improve their ability to pay for healthcare. However, nearly six in 10 patients (56%) either rarely or never received an estimate of out-of-pocket costs before they received treatment; 59% said they have been surprised by the costs they were responsible for when receiving their final bill.
Of patients who reported either paying a bill late, leaving a bill unpaid or letting a bill go to collections, three-quarters reported that they were always or often surprised by the costs they were responsible for in their final bills.
"These survey results tell us that consumers are less likely to have payment problems when they obtain more information about the cost of their healthcare services up front," said John Woody, vice president of product development for Transunion Healthcare. "Partly as a response to these issues, TransUnion Healthcare continues to improve payment experiences for patients and help ensure that healthcare providers capture all third-party reimbursements owed to them with the recent enhancements to our ClearIQ patient access platform."
TransUnion has enhanced its ClearIQ platform by adding Medical Necessity and upgrading its Insurance Eligibility and Benefits Verification solution. The ClearIQ platform now features customized business rules, an easy-to-read eligibility viewer, coverage discovery, alerts and work queue enhancements.
The improved Insurance Eligibility solution offers providers real-time electronic verification of patients' insurance eligibility and benefit levels for third party coverage. The update simplifies the payment experience for patients by enabling providers to comprehensively identify coverage options for specific procedures and customized to each patient's unique circumstances. By capturing accurate benefit information at the point-of-service, providers may be able to avoid errors and decrease claim denials while increasing collections from patients.
"From the patient's perspective, the latest enhancement equips them with accurate and essential information about their financial responsibility prior to treatment so they can make more informed decisions about their care and ability to pay," said Woody. "It arms providers with the tools they need to minimize claim denials, streamline front-end registration and, ultimately, reduce uncompensated care."
Medical Necessity, another integrated ClearIQ platform feature, automatically validates procedure codes against Medicare and Commercial Payer medical necessity rules. The solution may reduce the provider's financial-risk exposure for denied claims by identifying medical procedures which may not be covered by third party payors, before the provider submits the claim. Medical Necessity also improves patient satisfaction by enabling the provider to deliver transparent pricing information to the patient before the patient receives medical services.
The Medicare industry estimates that hospitals without a medical necessity program face an average of $960,000 annually in denials and an average staff cost of $53-$117 per denied claim to gather information related to the claim denial.
"Now, more than ever, it is critical that providers capture all reimbursements owed to them, given the impending changes to reimbursement structures under the Affordable Care Act and the introduction of healthcare exchanges," said Woody. "A failure to quickly and accurately verify patients' eligibility and benefits on the front-end can lead to costly billing errors and claim denials on the back-end and, ultimately, significant profit loss for healthcare providers and hospital systems."
Lincoln County Medical Center in Missouri will be one of the first hospitals to integrate Medical Necessity with ClearIQ's Patient Payment Estimation, Insurance Eligibility, ID and Address Verification and Propensity to Pay solutions, providing an improved patient financial experience. Lincoln will have the ability to clearly communicate to patients how much they will owe before receiving treatment and provide them with patient-friendly payment options, or financial assistance, based on their unique financial situation.
"We are excited about being able to provide our patients with the most transparent pricing information prior to receiving medical services," said Becky Kinsella, director of revenue cycle at Lincoln County Medical Center. "Combining medical necessity compliance checks with a contracts-based patient payment estimator and propensity to pay information empowers our staff with the tools necessary to educate patients' on their payment options. It also reduces our financial risk for claim denials post-service. We expect this to have a significant impact on our point-of-service collections and net revenue as we will know earlier in the process how much the patient owes, and what procedures will be covered by their insurance company."
TransUnion Healthcare's ClearIQ technology is an exception-based automated decisioning platform, which automates the work steps necessary to process a patient registration and provides the best possible patient financial experience. For more information about ClearIQ, visit: http://www.transunion.com/corporate/business/healthcare/emarketing/clearIQ_landing.page
TransUnion Healthcare, a wholly owned subsidiary of credit and information management company TransUnion, empowers providers with Intelligence in an Instant® by providing data and analytics at the point of need. TransUnion offers a series of data solutions designed to provide greater ease of use, accuracy and transparency in the revenue cycle process thereby assisting providers in lowering their uncompensated care. www.transunionhealthcare.com