Avita Health System Sees 47% Surge in Pre-Service Collections with Experian Health Partnership

A new case study reveals Avita Health System achieved a remarkable 47% increase in pre-service collections after implementing Experian Health’s Patient Estimates solution. The transformation addresses a critical challenge facing healthcare providers nationwide: improving financial transparency and reducing patient billing surprises. This development comes as regulatory scrutiny from the Centers for Medicare and Medicaid Services (CMS) intensifies, demanding greater accuracy in patient cost estimates.

The Rising Tide of Patient Financial Responsibility and the Need for Accurate Estimates

Healthcare costs continue to climb, placing an increasing financial burden on patients. Simultaneously, regulatory pressures are mounting on providers to offer clear, accurate estimates of those costs *before* care is delivered. Historically, many hospitals have treated patient estimates as a mere compliance requirement, often relying on imprecise methods and leaving patients facing unexpected bills. This approach erodes trust, hinders collections, and strains staff resources.

Avita Health System recognized this growing problem and sought a solution to improve patient understanding, enhance financial transparency, and minimize billing disputes. They found themselves grappling with outdated tools, inconsistent data quality, and a pre-service collection rate averaging a mere 1.5% per estimate – a clear indicator of a system in need of overhaul.

The Challenge: A System Rife with Inaccuracies

The core issue wasn’t simply a lack of estimates; it was a lack of *accurate* estimates. Patients at Avita Health System frequently expressed frustration upon receiving bills that differed significantly from their expectations. This disconnect not only damaged patient relationships but also created significant administrative overhead for staff tasked with resolving billing discrepancies. The existing process was unsustainable, and a more robust, data-driven approach was essential.

As Morgan Jones, Patient Services Manager at Avita Health System, aptly puts it, “Without a clear understanding of their financial responsibility beforehand, even a successful surgery can be overshadowed by the stress of an unexpected bill. By providing accurate estimates upfront, we help ensure that financial concerns don’t interfere with their recovery.”

Solution: Experian Health’s Patient Estimates – A Data-Driven Approach

To address these challenges, Avita Health System partnered with Experian Health to implement Patient Estimates. This solution leverages a comprehensive data ecosystem – including chargemaster data, payer contracts, claims history, and real-time eligibility information – to generate precise and reliable cost estimates.

The implementation extended beyond simply providing estimates. Avita also integrated Self-Service Patient Estimates into their workflow, empowering patients to explore costs for over 300 shoppable services independently. This proactive approach fostered greater transparency and patient engagement.

Empowering Staff with Knowledge and Support

The success of any technology implementation hinges on user adoption. Experian Health recognized this and provided Avita’s staff with comprehensive training on best practices for pre-service collections and point-of-service interactions. This training equipped them with the confidence to clearly explain estimates to patients and facilitate payment arrangements.

Furthermore, Experian Health’s dedicated support team provided ongoing assistance, proactively addressing issues and adapting to changes in payer rules. When payer regulations shifted at the start of the year, Experian Health swiftly adjusted the system’s logic to maintain accuracy.

Data Integrity: The Foundation of Accuracy

Avita also deployed Experian Health’s Power Reporting tool, enabling them to monitor hospital-level performance, reconcile accounts, and identify coding discrepancies. This commitment to data integrity was paramount.

“We routinely review all that data to reconcile and see where the underlying problems are so we can get even better with our accuracy,” explains Nathan Strome, Revenue Integrity Manager at Avita Health System.

Did You Know?:

Results: A Transformative Impact on Collections and Patient Experience

The implementation of Experian Health’s Patient Estimates yielded impressive results for Avita Health System. They now provide estimates to 95% of scheduled patients and 80% of walk-in patients, with an accuracy rate of 93%.

Pre-service collections soared by nearly 50%, increasing from $2.9 million to $4.28 million over a two-year period. Point-of-service collections also saw a dramatic rise, with a minimum of 11% collected upfront compared to just 1.5% before the training and implementation. These improvements demonstrate the tangible financial benefits of prioritizing patient financial transparency.

“We weren’t willing to sacrifice accuracy,” emphasizes Angela Murphy, Senior Revenue Cycle Coordinator at Avita Health System. “If estimates aren’t accurate, no amount of training and scripting will make a difference. Don’t assume your build is perfect. Audit your work and don’t hesitate to request changes when needed.”

Pro Tip:

What steps is your organization taking to improve patient financial transparency? And how are you leveraging data to ensure the accuracy of your estimates?

Frequently Asked Questions About Patient Estimates

1. How can accurate patient estimates improve patient satisfaction? Accurate estimates build trust and reduce financial anxiety, leading to a more positive patient experience.
2. What role does data quality play in generating accurate patient estimates? High-quality data – including chargemaster information, payer contracts, and claims history – is essential for precise estimate calculations.
3. Is patient estimate accuracy a regulatory requirement? Yes, regulatory scrutiny from CMS is increasing, making accurate estimates a critical compliance issue. Learn more about CMS transparency requirements.
4. How can Experian Health help my organization improve its patient estimate process? Experian Health offers a comprehensive suite of solutions, including Patient Estimates, Self-Service Patient Estimates, and Power Reporting, designed to enhance accuracy and efficiency.
5. What is the impact of inaccurate patient estimates on revenue cycle management? Inaccurate estimates can lead to billing disputes, delayed payments, and increased administrative costs, negatively impacting revenue cycle performance.
6. Beyond accuracy, what other factors contribute to successful pre-service collections? Effective staff training, clear communication, and convenient payment options are all crucial components of a successful pre-service collection strategy. HFMA offers resources on revenue cycle best practices.