Price Quote Checklist and Pricing System Development Guidelines
The following price quote checklist and pricing system development guidelines were developed in conjunction with the PATIENT FRIENDLY BILLING® "Reconstructing Hospital Pricing Systems" report.
What to include:
- Diagnosis and CPT/HCPCS codes and narrative
- Authorization/Medical Necessity established
- Standardized form (patient can use this as a basis to research the healthcare service on the website, etc.)
All charges associated with service
- Charges/prices/liability related to diagnosis/procedure
- Service packaging
Physician or ancillary services included or excluded (include communication that these services will be billed separately)
- Recommend including all charges in the estimate (physician and provider)
- Clarity around what charges are included in the price quote (and what charges ARE NOT included in the quote)
- Provide an estimate as comprehensive as possible with clarity added when necessary (remove the element of surprise)
- Communication to the patient should be as simplified as possible
Estimate of out-of-pocket expenses
- Discounts - provider policy
- How to apply for provider financial assistance (policy-website)
- 90 days same as cash
- Bank Loans
- Discount opportunities
- Other payment options
Wording that "this is an estimate"
- Estimate is not enough, define what estimate means (could be higher or lower)
- "Clarity Disclaimer" (should be written in prudent layperson language)
Wording that price quote is good for certain period of time
- Time period identified in writing
Quote should be no more than one page
What to do:
- Providers should determine and commit to level of quote guarantee (for example, any complications would be extra or would be included or set rate per day, etc.
- Quote must be written in Patient Friendly billing language and available in multiple languages.
- Providers should develop a script for the delivery of the quote.
- Look at and include historical data for price fluctuations.
- Eliminate high and low variables.
- Realign the Revenue Cycle (model policy and procedures developed in conjunction with payers based on provider needs, and customize guidelines).
- Financially counsel the patient regarding other payment options.
- Include clinical area/physicians in discussions about pricing transparency.
- Coding should be included in the scope of the revenue cycle (accuracy of coding and documentation).
- Focus on what the patient actually owes.
- Develop procedures on how we manage that interaction at the point of service or sooner.
- Focus on a patient-centric process.
- Publish guiding principles on discount/financial policies on the website.
- Develop and communicate/share/make available, a comprehensive transparent financial policy - very objective quoting process - standardized.
- Develop a policy that addresses how the information is displayed/processed in the facility (hard copy/in person/phone/website).
- Ensure that staff who engage in this discussion have the skill sets needed to delivery the quote.
- Develop and implement process changes by phases:
- Phase I
- Phase II
- Quality of care/clinical outcomes
- Phase III
- Quality of customer service (overall quality of the experience)
For more information, see the Reconstructing Hospital Pricing Systems report.
Publication Date: Wednesday, August 01, 2007