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:

Physician orders

  • 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
  • Ancillary
  • 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

Payment options

  • How to apply for provider financial assistance (policy-website)
  • 90 days same as cash
  • Bank Loans
  • Discount opportunities
  • HSA/HRA's
  • 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
    • Price
    • 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