Problems

  1. Medical group of over 300 physicians at multiple Ambulatory Surgery Centers faced reduced self-pay collections and increased cost of collection; high-volume of in-bound, time-consuming inquiries for accurate patient responsibility projections.
  2. Desired to be major metro market leader in delivering quality and price transparency.

Objectives

  • Load 25 insurance contracts (national + local) and payer policies to ensure highly accurate estimates. Include a self-pay model to provide discount rates relative to major carrier rates.
  • Provide a unified estimate for facility and professional fees before the time of service. Deliver an easy-to-understand, branded letter to patients detailing their benefits and out-of-pocket costs.
  • Enable staff to create cost-of-care estimates for patients within seconds.
  • Capture data and report on inbound price estimate inquiries.
  • Integrate with billing system to capture data on the back-end for accuracy of payment and linkage to upfront estimates.
  • Integrate with scheduling system and leverage existing benefits data from HIS and PM systems.
  • Track patient history of quotes and bills for improved patient relationship management.

Results

CaseStudy-Quote-Graph-Updatedtext

  • Increased pre-service patient responsibility collection by ~$600K/month at first two live locations combined.
  • Precision of estimates near 98% measured by back-end feedback loop (mitigating concern of patient refunds).
  • Integration with existing payment system API (via MD Clarity UI) to ensure a single transaction at the time of service.
  • Increased patient satisfaction by proactively providing out-of-pocket cost data, thereby increasing price transparency.
"With MD Clarity in place at our surgery centers we can now provide patients with precise estimates for surgeries within seconds. We have not only increased patient satisfaction but also our up-front collections of medical bills, saving us a lot of hassle. "
- Manager, Woodbury & Landmark Ambulatory Surgery Centers

Tools Utilized

Accurate OOP cost breakdowns for patients

Instantly verify patient benefits in batch and real-time

Instantly verify insurance coverage