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"I need to produce Advance Cost Estimates
for prospective patients ..."
"The Harvest Consumer Pricing Tool is
exactly what we've been looking for to solve our estimating
needs."
Manager, Patient Accounts Southcoast Hospitals Group
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Consumer Pricing
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Includes a Wizard that creates printed cost
estimates for either insured or uninsured patients
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The Challenge:
Transparent
pricing in health care has arrived -- big time. With an increasing number
of employers being forced to offer health plans with high deductible and
high coinsurance amounts to remain financially viable, their employees
are now faced with price shopping their care to the most affordable
provider. Moreover, the uninsured are seeking essentially the same level
of payment discounting previously granted to only the high-volume payors like managed care health plans. Providers need
to effectively respond to this new trend in consumerism by supplying
typical cost information to prospective patients in advance of their
care. Unless the provider has ready access to a database containing
accurate charge and insurance payment data for a wide range of medical
services, gathering this information is a very laborious task to say the
least. Moreover, health care facilities need to rely upon this
information to develop a realistic process that insures the collection of
this self-pay revenue from these new age retail customers.
The Solution:
The
Consumer Pricing Tool in Harvest provides an easy-to-use, yet very
effective means of providing prospective patients with advance cost
estimates for their medical care by:
- Using
actual claim and payment data to quickly retrieve typical charge and
payment data using CPT® codes or ICD-9 procedure codes to identify
specific types of medical cases.
- Qualifying
the claims history for the varying effect of Operating Room,
Recovery Room and Length of Stay on charge and payment data.
- Quickly
producing an accurate work list of historical claims that the user
can use to "drill-down" into individual cases and their
charges and payments for added analysis.
- Producing
a specialized Consumer Pricing Report that summarizes charge and
payment information for the specified procedure into three key
metrics: the highest claim, the lowest claim and the mean claim
data.
- Using
a built-in Wizard to create and print Advance Cost Estimates for
either insured or uninsured patients.
- Calculating
an insured patient's estimated cost for their medical care using
their actual deductible, copay % and
annual out-of-pocket maximum.
- Calculating
an uninsured patient's estimated cost for their medical care as
either a % discount off the typical charges for the procedure or as
a % of typical reimbursement paid by insurance companies.
CPT is a registered trademark of the
American Medical Association
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