Kaitlin Howard

By Kaitlin Howard

Kaitlin Howard is a researcher and writer producing insightful content across the healthcare revenue cycle. She has written and produced content for Zelis, Waystar, and Recondo Technology, as well as agencies. With a B.A. in English and Writing from University of Denver, Kaitlin stays current on market updates on claims management and healthcare payments, publishing a regular educational blog series on industry trends and Zelis offerings.

Healthcare is becoming increasingly consumer-centric (we’re looking at you price transparency). There’s no secret there.

In fact, the No Surprises Act (NSA), signed into law in December 2020, seeks to protect patients from surprise medical bills and prohibits balance billing for certain out-of-network care. The Transparency in Coverage Rule (TiC), published October 2020, provides consumers better insight into the cost of services before obtaining care and receiving a bill.

As such, healthcare organizations must now create a consumerism strategy that highlights price transparency to meet both NSA and TiC compliance, while still improving the patient experience and accelerating cash.

But that’s not all. Your strategy must demonstrate that you actually care.

Price transparency itself is not a goal. Rather, it’s a means toward multiple goals around your patients and your bottom line, like avoiding sticker shock, facilitating shopping, and lifting the veil on high prices. It is only after achieving these goals geared toward patient experience that you can achieve your other goal: actually getting paid.

And while these new requirements will add complexity to healthcare claim processing and administration, both pre- and post-service, these rulings’ most significant impact lies in two key areas: transparency and member engagement and out-of-network (OON) claim processing and payment.

But we know what you’re thinking. Those deadlines for compliance are rapidly approaching. And it’s difficult to know where to begin.

So let’s get started.

1. Do right by your patients.

In a recent survey, almost two-thirds of patients reported that there is not enough information regarding the cost of medical services before the time of service. Providing patients with the out-of-pocket cost before they get care helps them prepare for its financial impact. No more “surprise you owe this much!”. Hello, public trust in the health care system (and, more importantly, in your organization).

Accurately estimating out-of-pocket costs and having pre-service financial discussions to answer patient questions puts you one step ahead of your competitors, one step toward compliance, and one step closer to accelerating your cash.

You read that right. Having pre-service financial discussions accelerates your cash.When a patient is notified of their portion of the bill upfront, they are able to take the steps they need to find the money to pay prior to service. And when patients pay a portion of their balance pre-service, they are more likely to pay the remainder of the bill. That’s why it is so important to determine and share the price of the patient encounter before the day of service.

2. Facilitate shopping around.

While 70% of patients would like to discuss costs with their providers, only 28% of them said doctors or their staff brought up a price conversation with them prior to service. Those are rookie numbers, to say the least.

Consumerism is a huge goal of price transparency. Plain and simple. Under the consumerism model, patients are expected to compare prices and quality between organizations. But the use of price transparency tools is not yet common enough to affect overall healthcare spending.

So how can you help? Make your pricing tools more easily accessible and user-friendly. Don’t have any of these tools set in place, yet? Get some.

Price shopping impacts patient decisions about where to receive their care. If you have tools in place to ensure that your prices are readily available and accessible to patients pre-service, they are more likely to receive care at your organization.

3. Ensure your patients can (and will) pay for the care you provide.

According to a recent study, 95% of patients indicate they are willing to pay a bill, while only 20% of provider organizations indicate they have the online infrastructure needed. Which doesn’t balance out well when paired with the fact that about half of the public, regardless of socioeconomic status or health, say they are either “very worried” or “somewhat worried” about being able to afford unexpected medical bills or their health insurance deductible.

The Wrap Up

The No Surprises Act and Transparency in Coverage Rule will impact all healthcare organizations, from large health plans and systems to small medical offices and individual providers. As such, leaders across the healthcare industry must directly understand the details of the legislation prior to implementation or have a trusted advisor with legislative expertise who can guide them to appropriate solutions.

While it’s true that healthcare pricing is more available now than in previous years, much of it is hard for the average patient to understand and use. By going one step further than bare minimum compliance and truly explaining prices, cost estimates, and other financial information, you can proactively steer your patients to helpful information and give your organization an edge over your competitors.

Moreover, with clear information about how much they will actually owe before their visit, you can check off your “compliance” box and rest easy knowing your patients are even more likely to actually pay you. In full.

To further explore getting started with NSA and TiC compliance, reach out to your Zelis representative or contact us here.

For access to additional information, visit Zelis’ No Surprises Act Information Hub.