Many Americans struggle with unexpected medical bills, and the disconnected world of payments in healthcare has become increasingly complex during COVID-19. 70% of consumers say healthcare makes a payment more difficult than any other industry. When it comes to healthcare, the majority of Americans want price estimates upfront. 84% of Millennials and Gen Z and 65% of Baby Boomers want these estimates, yet only half of them are accurate, adding to payment confusion. In 2019, 40% of consumers were surprised by a high medical bill; almost half came from a hospital visit and 1 in 5 came from surgeries. 67% of Americans worry they could not afford a surprise medical bill. Even with employer-sponsored insurance, 4 in 10 struggle to afford healthcare.
The rise in popularity of high deductible health plans has contributed to unpredictable medical costs. From 2007 to 2017, almost 20 million Americans were enrolled in high deductible plans. Plans with a health savings account have risen 450%, and without a health savings account, they have risen 231%. As people make the switch to high deductible plans they report more instances of unexpected medical bills, increased out-of-pocket costs, and confusion about payment responsibility. 69% of patients attempt to learn about costs before or during their appointment and 42% simply wait for the bill to arrive before they address it.
Wasted spending in healthcare is a significant issue. One-quarter of wasted spending results from the time and money spent on collecting, processing, posting, and recording payments. Accepting a $20 copayment in cash can cost up to $50 to process. Payments are collected from two sources: insurance payers, consumers, or a mix of both, but all of these payment methods are processed at different times in the payment cycle, making it difficult to manage.
Denied claims contribute to wasted spending as well. 10% of insurance claims are denied. Common mistakes that contribute to denied claims include incorrect patient identification, services not covered, prior authorization, and out-of-network providers. Mistakes can also occur when systems are interoperable, either through manual data transfer between systems or difficulty verifying insurance eligibility. Of the denied claims, 35% are reworked and resubmitted, which can cost up to 18 times more than a claim that was correctly filed the first time. That being said, 90% of denied claims are avoidable; eliminating rework for 100 claims a month would save the average practice $37,000 a year and could save a hospital $149,000 annually.
Solutions for payment issues in healthcare are insurance eligibility verification, contactless check-in and payments, and connecting healthcare systems. The average practice can save 11 hours of administrative time per day and up to $4,500 per month using automated insurance eligibility verification. Through pre-registration, collecting necessary data including photo ID and insurance card, as well as demographic data is simple. The data collection confirms if coverage is valid on the date of service, notifies the patient of their responsibility for copays and coinsurance, explains prior authorization and referral requirements, and identifies insurance payers and where to send claims. All of this information is then used to calculate accurate, upfront pricing estimates for patients.
Many healthcare organizations have switched to contactless check-ins and payments amid the COVID-19 pandemic to slow the spread of the virus. Patients will call or text the office to notify them when they have arrived for their appointment and then wait in the parking lot until the clinic is ready. This process minimizes patient-to-patient interaction and contamination of paperwork, pens, and other surfaces. Digital registration documents, including COVID-19 screening questions, consent forms, insurance documentation, and review of outstanding balance and copays, can also be completed before arrival.
PracticeSquire efficiently connects healthcare systems and is beneficial to all parties involved in the management of healthcare payments. This will become increasingly important as vaccines become readily available because providers will need to efficiently process a flood of insurance claims.
Connected healthcare systems allow patients to easily check in from anywhere without the risk of infection and save information with a single login, eliminating the need to carry cards. Office staff also have a reduced risk of infection through the exchange of documents and payments. They eliminate mistakes and rework of claims from misread insurance cards, and gain more time to focus on other tasks. Insurance providers experience reduced administrative workload for greater productivity and cost savings and fewer mistakes, administrative headaches, and reduced turnover. Getting paid is fast and simple with PracticeSquire.