Working for a healthcare organization
Assume that you work for a healthcare organization and a patient wants to learn more about the cost for a procedure ordered by their provider. They have asked the following questions to Patient Scheduling:
How much would the procedure cost because I have not yet met my deductible?
Do I need pre-authorization?
Is there a facility charge in addition to the physician charge?
What other charges would be incurred?
In your initial post, include the following details:
Explain why each of these four questions is significant for the patient. Add evidence to support each explanation. You may also share an experience on any one of these questions.
Provide an explanation of how procedural expenses are determined.
Describe how patient perception towards payment can affect the revenue cycle for a healthcare organization.
Sample Solution
Understanding Procedural Costs: A Patient's Perspective
For patients, understanding the costs associated with a scheduled procedure is crucial for several reasons:
- Financial Planning:
- Question:"How much would the procedure cost because I have not yet met my deductible?"
- Significance:Knowing the estimated cost allows patients to plan their finances This includes budgeting for out-of-pocket expenses like co-pays, deductibles, or coinsurance, ensuring they are prepared for the financial burden.
- Informed Decision-Making:
- Question:"Do I need pre-authorization?"
- Significance:Understanding the need for pre-authorization empowers patients to take proactive steps. This might involve contacting their insurance provider to ensure coverage and avoid potential denials or delays in care.
- Transparency and Trust:
- Question:"Is there a facility charge in addition to the physician charge?"
- Significance:Knowing about all potential charges, including facility fees, allows for clear communication and transparency. This builds trust between the patient and the healthcare organization, fostering a positive patient experience.
- Managing Expectations and Avoiding Surprises:
- Question:"What other charges would be incurred?"
- Significance:Being aware of additional potential costs, such as anesthesia or lab fees, helps patients manage their expectations and avoid unexpected financial surprises after the procedure.
- Physician fees:Set by the healthcare provider and vary based on their training, experience, and practice location.
- Facility fees:Charged by the hospital or clinic where the procedure is performed to cover facility upkeep, equipment, and staff costs.
- Anesthesia fees:Billed by the anesthesiologist separately from the surgeon's fee.
- Lab fees:Costs associated with any laboratory tests performed before, during, or after the procedure.
- Insurance coverage:The patient's insurance plan dictates the amount of coverage for each cost component, leaving the remaining amount as the patient's responsibility (co-pay, deductible, coinsurance).
- Negative perception:Unclear and unexpected costs can lead to patient frustration, delayed payments, and increased chances of bad debt for the organization.
- Positive perception:Transparency, clear communication, and accurate explanations foster patient trust, leading to timely bill payments and improved cash flow for the organization.