Hospital Financial Risk Assessment Tools Not Limited to ERM

Karen Minich-Pourshadi, for HealthLeaders Media , March 21, 2011

To move beyond a two-dimensional check of a patient’s ability to pay, hospitals and health systems should use the existing eligibility information and cross reference it with the information from your payers’ contracts. Then the system should assess the patient’s ability to pay, and factor in an estimate of the cost of a procedure, Bohnsack says. By merging all these systems, a hospital can provide the patient with a far more accurate estimate of what they may owe for their care. Moreover, they have the tools they need to explain how they arrived at the estimated cost.

It is the explanation and the transparency around the bill that not only leads to hospitals getting paid the correct amount, but also yields a better patient response to the bill. Over the years, many healthcare leaders have pooh-poohed the idea of estimating the cost of a procedure, saying the number would be inaccurate due to all the possible avenues of treatment.

However, by using the gross charges McLaughlin mentions above, hospital administrators should be able to arrive at a reasonably accurate amount. Moreover, Silva-Craig notes that if a bill is based on one procedure, for instance natural childbirth, and another procedure is performed, such as a C-section, when the billable amount changes the patient will have a clear understanding of why.  

As financial leaders search for the next place to reduce costs, it may be time to spend money to achieve that end. By allocating $20,000-$40,000 toward adding technology that pulls all of your existing systems' information together for your front-office workers, you can improve not only your point of service collections but also your patient collection interactions.

For more insight from healthcare finance leaders, see the 2011 HealthLeaders Media Industry Survey.

Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media.
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