One Patient's Surprising Post-Op Pain: A $12,000 Bill

Meet David Galbraith. David is a successful business owner and generally healthy individual who has required relatively minimal extended healthcare in the course of his adulthood. That’s why he found his recent experience with an outpatient surgery quite jarring—and not very patient friendly at all.

David GalbraithWhen David exhibited symptoms, he was referred to a respected physician who accommodated a prompt appointment and swiftly booked a procedure. David, familiar with the high deductible of his insurance coverage, was pleased to take care of his situation in short order without concern regarding cost. After all, he understood his coverage, as he’d chosen it himself, and he’d asked the right questions in that process. Other than being told when and where to report and how to physically prepare for his simple operation, he received no other counsel from the healthcare provider, particularly regarding costs and payments.

The procedure went extremely well. “The whole thing took no more than 45 minutes,” David reports. “I arrived at the hospital at 7 a.m. and was home by 10:15.”

Perhaps that’s why it was so shocking when he received a bill for over $12,000 three weeks later. Though the dollar figure was unexpectedly high, David was most concerned that he’d been given no warning beforehand and that the bill received was so poorly presented. The language was cryptic, and while the statement was very detailed (“$57 for a hospital gown?!”), the information was not presented logically.

“There were excessive details, yet none of it really made sense to me as a patient,” David explains. “It was difficult to understand...and left me asking why (individual line items) cost so much and what could I have done differently to keep costs down.”

Ultimately, David was forced to spend valuable time on the phone with his insurance company and the provider trying to make sense of the bill and reconcile it accordingly. All told, he’s spent far more time dealing with billing than he did receiving care.

“Now that more of us are on high deductible plans, there needs to be simplified bills for patients,” he summarizes. “When we get a bill we don’t understand, it is both time consuming and frustrating to straighten everything out.”

For David, the frustration isn’t so much about the costs of the care (“It’s okay to pay fair market value…”). He’s most distraught by how poorly the information was conveyed. From obvious lack of financial counsel prior to the procedure to the baffling bill that showed up in the mail three weeks later, he experienced gaping holes in the communications process. Those holes would likely have been filled with a simple pre-admission conversation about billing and a patient friendly statement with clear summarization and key information called out.

Certainly, the walk in David’s shoes is well worth the journey, as his experience is an all too familiar one. Though many of us in our industry are genuinely committed to the idea of patient friendly billing standards, they are not always put into practice. We remain tethered to outdated modes of billing while the trends have catapulted forward. Here are three “Do Now” steps we should all employ to avoid putting patients in adversarial roles come billing time.

- Pre-admission Counsel and Estimations: It’s extremely helpful to provide patients a road map so they understand the financial aspects of their care before it occurs. It should be standard policy that all patients be counseled regarding payment responsibility and cost estimates based on their health coverage prior to admission.

- Online Pre-registration: By pre-registering patients online, providers have the opportunity to vet coverage issues, make determinations about charity care cases and offer patients more detail regarding potential payment responsibilities. This approach requires system updates, but it is well worth the effort. If your organization is not presently set up for online pre-registration, take this as your cue to pursue this solution.

- Friendly Billing Statements and Options: Apply the HFMA standards for patient friendly billing to your statements immediately. Redesign the statements to be more patient-friendly, with key information highlighted and details appropriately summarized for more simple comprehension. Give patients more ways to pay by offering online account management.

At Emdeon, we understand that patients who are confused about their financial responsibilities are more likely to pick up the phone and call your billing department instead of picking up their pen to write a check for payment. That’s why developing a clear and concise, patient-friendly billing statement is important for your bottom line. Call 877.EMDEON.6 (877.363.3666) or visit us online to discover how Emdeon ExpressBill Services can help improve cash flow at your organization.

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Complimentary Case Study Download: Baptist Health Systems Sees the Pay-off of Online Patient Payment Solutions

Offering patients the ability to pay online aids in collecting revenue more promptly and fully, with less drain on staff time and resources. When Baptist Health Systems (BHS) in Jackson, Mississippi implemented Emdeon Patient Pay Online in March 2010, the organization was in a revenue optimization mode, making the efficiencies associated with implementing an online payment collection portal incredibly appealing and necessary.

More than a year after launch, Angie Buckley, Director of Business Services, reports that the system has performed as anticipated in aiding collections. In addition to helping BHS reduce costs by automating the collection of patient payments, the most positive result for BHS has been the empowerment and satisfaction of patients.

Download this complimentary Emdeon customer success story.

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Visit Emdeon at a Tradeshow near You

Emdeon exhibits at many tradeshows throughout the year where you can learn more about our full suite of Revenue and Payment Cycle Management Solutions, as well as, new products and features on the horizon. Come visit us at the following tradeshows:

MO HFMA- Multi Chapter Conference 8/24/11—8/25/11;   Kansas City, MO

CO Health and Hospital Association 9/7/11—9/9/11;   Vail, CO

Nevada Hospital Association 9/7/11—9/8/11;   Lake Tahoe, NV

MD AAHAM 9/13/11—9/15/11;   Ocean City, MD

Tri-State KY, IN & OH 9/14/11—9/16/11;   Florence, IN

ME HFMA 9/15/11—9/16/11;   Northpoint, ME

HIMSS Summit of the SE 9/28/11—9/29/11;   Nashville, TN

TN HFMA 10/12/11—10/14/11;   Gatlinburg, TN

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Follow Emdeon on Facebook and Twitter

Find us online to learn about innovative new solutions and special offers or to provide feedback on Emdeon products and services you use. Emdeon regularly posts updates and offers valuable resources to keep you on top of industry trends and current information, including healthcare reform, emerging technology, best practices and more. Use your computer or mobile device to receive Emdeon updates on free webinars, new product launches, important news articles and upcoming tradeshows. You can also visit our YouTube channel to watch inspiring customer testimonials and insightful product videos, or join Emdeon on LinkedIn to connect with colleagues. Click the icons below and get social with Emdeon today!


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Three Emdeon Revenue Cycle Management Solutions Achieve HFMA Peer Reviewed Designation

Emdeon Assistant, Emdeon Claim Master® and Emdeon Payment Integrity Services have earned the Peer Reviewed designation of the Healthcare Financial Management Association (HFMA). The HFMA Peer Reviewed designation places these Emdeon solutions on a short list of prestigious products and services that have been proven effective by industry expert volunteers, product customers and independent HFMA staff.

Emdeon Assistant, an automated patient eligibility and benefits verification tool, was awarded the designation for the fourth year in a row. And for the second straight year, both Emdeon Claim Master, a web-based claims management solution, and Emdeon Payment Integrity Services, which provides accounts receivable audit and recovery services for healthcare providers, were selected for Peer Reviewed status. All products presented for the certification must meet predetermined standards as established by HFMA in areas such as product effectiveness, quality, overall value and customer support to earn the "Peer Reviewed by HFMA" designation.

"By helping providers better manage the complexities of the revenue and payment cycle, Emdeon's solutions allow our customers to be more efficient from the initial patient encounter through third-party reimbursement and final payment," said George Lazenby, chief executive officer for Emdeon. "We are pleased to receive corroboration from our customers and peers that Emdeon's solutions are effectively addressing healthcare market needs."

Emdeon Assistant simplifies patient registration through real-time automation of patient eligibility and information verification tasks and interfaces with most existing registration systems. Emdeon Assistant accesses a wide range of information from available government and commercial payers including insurance eligibility, referrals, pre-authorizations and claim status. Emdeon Assistant also has the ability to perform address verification, payment prediction, charity screening and discount assessment.

Emdeon Claim Master's innovative and easy-to-use web-based interface allows hospitals, health systems and provider practices to manage their entire billing process across all facilities. Emdeon Claim Master utilizes unique tools to aid decision support, provide dashboard snapshots of claims inventory, manage workflow and prioritize resources. In addition, Emdeon Claim Master provides trending analytics at the patient level while illustrating the claim lifecycle, enabling the user to monitor the end-to-end experience of individual claims in the claims management process.

"Emdeon Claim Master is one of the most important revenue cycle tools we have installed at Martha Jefferson Hospital," said Albert Payne, revenue cycle manager at Martha Jefferson Hospital in Charlottesville, Va. "This claim management solution automates the import of bills from our patient accounting system and sends clean claims to Emdeon without any staff intervention."

Emdeon Payment Integrity Services consists of professional services and technology solutions that enable healthcare providers to transform previously written-off government managed care and commercial payer underpayments into realized revenue. Coupling industry expertise with sophisticated tools to work with providers, Emdeon Payment Integrity Services focuses on key areas of the revenue cycle where providers traditionally lack the in-house resources to address payer underpayments including accuracy of payments and collection issues. Visit PRNewswire to read this and other Emdeon press releases.

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HFMA Webinar: "Stop Misdiagnosing Undiscovered Eligibility as Self-Pay: Strategies for Optimizing Patient Access"

Attend an HFMA Webinar to Learn More

This program will explore resources available to help proactive and forward-thinking hospitals address the reimbursement risk associated with their uninsured patient population. By optimizing processes and leveraging technology and professional services to discover funding sources through federal, state and community benefit programs, providers can become advocates for the uninsured in their communities.

In this session, Sentara will share their experiences and strategies for optimizing eligibility verification and enrollment for qualified patients to improve the providers’ bottom line.

Register now to attend an HFMA Webinar September 14th 3:00 to 4:30 pm EST to hear more about this topic!

Brenda Loper
Director of Patient Registration Services
Sentara Healthcare

Steve Kilguss
Vice President of Product Management

After This Webinar You Will Be Able To:

• Identify the common short-falls and limitations of home-grown eligibility determination programs
• Describe why most patients who are qualified for government and charity care won’t ever apply without your help cutting through the red-tape
• Discuss how to put technology and workflow processes in place to assist indigent patients in qualifying for public assistance programs
• Develop a strategy for managing your uninsured patient base to generate meaningful incremental cash flow

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