Projected Patient Appointment Estimate
To guarantee that patients can make informed decisions and are cognizant of their financial obligations, it is imperative to communicate their potential out-of-pocket costs in advance and verify their eligibility no less than two days before their scheduled appointment. This practice will also furnish the most accurate estimate of the services they may receive.
As of March 2023, medical debt generally does not affect credit scores in the United States. This is due to amendments to the Fair Credit Reporting Act (FCRA), which prohibit medical debt from being included on credit reports. The Consumer Financial Protection Bureau (CFPB) has issued a rule that further reinforces this ban. In compliance with these regulations, the three major credit reporting agencies (Equifax, Experian, and TransUnion) no longer report medical debt on credit scores.
If private practices do not verify patient eligibility and estimate service costs before providing treatment, collecting patient payments for medical services can be challenging. This is further complicated if medical debt is not reported to credit reporting agencies. Many practices find it difficult to adequately check patient eligibility due to the amount of work required and the unskilled labor often employed in front office roles.
ABC checks eligibility and gives the practice a closed possible estimate of the service for new patients and the established patients.
This is how it works.
Each patient’s estimated balance and cost for the appointment are shared with the practice 48 hours in advance, allowing the practice to inform the patient accordingly.
ABC retrieves appointment information directly from the practice’s PMS/EMR. Each patient’s visit type is mapped to the closest and highest possible CPT code for the service.
Eligibility is verified for each patient’s upcoming visit through payer portals and direct communication with payers.
An approximate estimate is calculated based on the provider’s network status, patient deductible, copay, co-insurance, and out-of-pocket expenses.
A detailed spreadsheet is sent to the practice before appointment reminders are sent to patients, ensuring they receive the most accurate cost estimation.
Key Benefits of ABC’s Eligibility Verification Services:
- Early Verification: Complete eligibility checks at least 48 hours before a patient’s visit.
- Comprehensive Coverage Checks: Verify patient demographics, benefits, deductibles, copays, and coinsurance across all payers.
- Proactive Financial Insights: Generate and communicate clear patient financial responsibility estimates ahead of time.
- Optimized Revenue Cycle: Reduce denials, enhance reimbursements, and prevent revenue leakage.
- Enhanced Patient Satisfaction: Provide transparency regarding financial obligations, fostering trust and confidence.
- Global Cost Savings: Benefit from efficient, cost-effective processes delivered on a global scale.
- Guaranteed Accuracy: Rely on standardized procedures and expert oversight for precise, complete data.