Price Transparency Initiatives?Do they help the average American? (attached files are the screenshot of the book to help answer the questions) Many states and the federa
Price Transparency Initiatives—Do they help the average American? (attached files are the screenshot of the book to help answer the questions)
Many states and the federal government have price transparency regulations. The textbook provides examples from the Washington State Hospital Association and New Hampshire’s HealthCost. Search for additional price transparency examples and review the contents and information provided. After reviewing the sites, prepare an opinion paper (1 page APA format double-spaced).
- Do you think price transparency initiatives help the average American better understand the cost and quality of the services at various hospitals?
- Is there enough information to help a patient choose the best physician and hospital for treatment?
(the powerpoint attached is just a summary of the chapter, "price transparency part 1,2,3,4" is the pages of the book)
Principles of Healthcare Reimbursement and Revenue Cycle Management Chapter 9: Revenue Cycle Front-End Processes—Patient Engagement
Anne Casto, RHIA, CCS
Susan White, PhD, RHIA, CHDA
ahima.org
© 2021 AHIMA
ahima.org
Learning Objectives
Describe the processes included in the front- end of revenue cycle component
Analyze patient financial agreements
Explore the scheduling and registration process
Understand the impact of cost sharing on the patient’s financial position
© 2021 AHIMA
ahima.org
Revenue Cycle
Revenue cycle: regular set of tasks and activities that produce reimbursement
Revenue cycle management: the supervision of all the administrative and clinical functions that contribute to the capture, management, and collection of patient service reimbursement
© 2021 AHIMA
ahima.org
Front-End Processes
Patient Engagement
Middle Processes
Resource Tracking
Back-End Processes
Claims Production and Revenue Collection
Front-end Processes—Patient Engagement
Begins with the patient schedules services
Ends when the patient registers at the point of care
© 2021 AHIMA
ahima.org
Schedule services
Prior authorization (if required)
Registration
Financial counseling
Scheduling Services
Contact the healthcare provider
May schedule via a patient portal
Investigate cost sharing (out-of-pocket costs)
May receive pretreatment cost estimate from provider
Price transparency
Federal and/or state regulations require providers to make their standard or list prices available
Review figures 9.2 and 9.3 from textbook
Review example 9.1 from textbook
© 2021 AHIMA
ahima.org
Prior Authorization
P A Tips
Check P A requirements before providing services or sending prescriptions to the pharmacy
Establish a protocol to consistently document data required for P A in the medical record
Select the P A method that will be most efficient, given the particular situation and health plan’s P A options
Regularly follow-up to ensure timely P A approval
When a P A is inappropriately denied, submit an organized, concise, and well-articulated appeal with supporting clinical information
© 2021 AHIMA
ahima.org
Prior Authorization (P A)
P A is a process of obtaining approval from a health insurance company before receiving healthcare services
P A is a method of controlling the cost of care
Patient Intake
Patient registration
Collection of data
Patient’s medical history
Insurance coverage
Image of insurance card—stopgap to correct data entry errors
Agreement to fulfill financial obligations
Patient financial responsibility agreement
HIPAA authorization form
Advance beneficiary notification of noncoverage (A B N)
© 2021 AHIMA
ahima.org
Patient Financial Counseling
Healthcare payment plans
Healthcare loans
Payment support from manufacturers
Drug copay cards
Not available to patients with government-sponsored health insurance
© 2021 AHIMA
ahima.org
Patient Connection
Olivia’s husband, Tony, was prescribed a new drug for his asthma. The drug is not on the Super Payer formulary and therefore the copayment amount is 30 percent of the $3,110 price each month.
Olivia and Tony were able to locate information about a copay card that would reduce the copayment amount to $0 for the drug.
© 2021 AHIMA
ahima.org
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