Avoiding Surprises in Healthcare Revenue Cycle Management
AvatarThe HealthPay24 Team


25% of Americans report delaying medical care for serious conditions due to the cost of treatment. Delays in receiving medical treatment not only affect the lives of individuals as they suffer from chronic pain, but it drains the medical system and the economy. Workplace productivity goes down when employees are not healthy. Emergency departments, which are already overloaded with patients, receive an increase of people seeking treatment for conditions that have worsened due to the absence of routine care. Healthcare revenue cycle management is a concern for executives at all hospitals. Increasing transparency between providers and patients not only improves their relationship but enhances the patient financial experience as well. 

The Transparency Act

In June 2019, the federal government issued an executive order called “Improving Price and Quality Transparency in American Healthcare to Put Patients First.” The Transparency Act went into effect on January 1, 2021, and has been updated since. According to the order, hospitals must provide procedure estimates on their websites and also directly to patients if requested. This executive order intends to help patients make decisions about their healthcare. 

The Transparency Act aims to remove barriers to receiving medical care, including providing pre-service estimates so that patients do not receive shocking medical bills after the fact. The most effective efforts allow patients to see charges the providers bill. With this information, patients can compare the price of services among providers.

By encouraging patients to shop around for medical services, the Transparency Act is moving healthcare more closely into alignment with modern consumerism, where consumers compare prices and research brand quality before purchasing. But, the medical system is complex. Medical codes are difficult for the average patient to decipher. Shopping for surgery is not as simple as shopping for the best pair of jeans. 

Complying with the Transparency Act

There are three key provisions hospitals need to comply with in the Transparency Act:

  1. Publish an expanded definition of “standard charges,” which includes gross charges (chargemaster), payer-specific negotiated charges, discounted cash prices, and de-identified minimum and maximum negotiated charges. 
  2. Post negotiated and self-pay pricing for 300 “shoppable services.”
  3. All pricing information needs to be in a consumer-friendly, searchable format easily accessed on the hospital website.

Hospitals nationwide are responsible for complying with the Transparency Act, yet only 14% are currently compliant. Non-compliant hospitals face fines of up to $300 per day. Healthcare revenue cycle management must comply with the Transparency Act as soon as possible to avoid an accumulation of fines. 

Challenges of complying with the Transparency Act

Like any major change, adjusting to the Transparency Act takes a lot of money, time, and resources. The healthcare industry faces unique challenges other industries don’t when it comes to implementing change. Insurance companies are major players in healthcare revenue cycle management, but they are independent of the hospital. Hospitals cannot run the procedure through a patient’s insurance, which can make a price estimate difficult to provide. 

Healthcare Revenue Cycle Management

Patient Trust

Price transparency is key to building patient trust. Posting the chargemaster as required by the government is the first step. Patients can become confused as they try to navigate a large spreadsheet full of medical jargon to make decisions about their healthcare. Patients may not know what questions to ask or to whom. Going the extra mile to support your patients in making informed decisions about their healthcare will develop your hospital’s reputation as trustworthy and supportive. As people increasingly spend more time deciding where to seek medical treatment, a hospital’s reputation will matter more and more. 

Some ways to offer support and transparency:

  • Provide a webpage with an explanation of common medical codes.
  • Have a phone line available for patients to ask questions.
  • Train staff to explain price differences with other area hospitals.

Financial transparency makes patients feel more comfortable and loyal to their providers. Patients want to receive care from providers they can trust. Focusing on gaining patients’ trust will ultimately improve healthcare revenue cycle management.

The age of transparency and healthcare revenue cycle management

Transparency goes beyond simply posting the chargemaster. This large spreadsheet can scare a patient away. They will see that surgery will cost tens of thousands of dollars and feel they can not afford it. But, the amount they will pay is much smaller with their insurance. Financial counselors can explain these nuances and help people access the care they need. 

Most patients would make a partial payment before the service if they received an estimate of the cost. Although getting up to standard with the new regulations can be costly in both time and money, doing the homework will improve healthcare revenue cycle management in the long run. Increased transparency and accurate, predictable billing help patients budget for their healthcare and avoid non-payment of unexpected charges.

Healthcare Revenue Cycle Management

Standing apart in the age of increased transparency 

As healthcare becomes more closely aligned with modern consumerism, patients will consider more factors when deciding where to seek medical care. Of course, the price will be a huge factor, but patients will also choose their providers based on other factors. Defining your hospital’s brand and what makes it unique will influence patients’ decisions.

Some categories that influence patients’ choices:

  • Peace of mind—patients will choose a hospital that consistently provides a positive experience. 
  • Reputation—familiarity will draw people to you. 
  • Shared values—clearly stating values on your website and marketing materials will attract like-minded patients. 
  • Quality—people will pay more for higher quality; state-of-the-art technology and attention to detail will distinguish your hospital.  

Technology in the age of increased transparency 

Technology drives consumer decisions. Many people begin shopping online. It will drive patient decisions as they spend time shopping for services. Where your hospital appears in a google search and how easily navigable your website is could determine a patient’s decision. Although having staff on hand to answer questions is important, having technology in place will draw people to your hospital and improve healthcare revenue cycle management. 

Some tools that can help draw patients to your hospital include:

  • video demonstrating how to read the chargemaster to the everyday patient 
  • price-checkers for procedures calculating the cost of procedures across area hospitals 
  • simple price breakdown and payment options

HealthPay24 empowers healthcare provider organizations to maximize patient self-pay revenue by providing the most innovative and comprehensive payment solutions. They can provide a clear estimate during pre-service and affordability options so patients can proceed with their treatment for cancer, serious injury, and rehabilitation, or any other long-term medical treatment. 

HealthPay24 is the only patient payment platform that allows providers to take payment off of the estimation and reconcile it immediately with accounts receivable, allowing providers and patients to see the payment in real-time. HealthPay24 reduces financial barriers by replacing error-prone, manual processes with automated, modern technology. HealthPay24’s technology gets revenue in the door faster

HealthPay24 is the payment collecting service patients trust, with excellent customer satisfaction and 95% customer retention. 

Transparency is the way of the future. Providers and partners like HealthPay24 are working together to make sure that increased transparency benefits patients.

Contact us today to learn more about how HealthPay24 can help enhance transparency in your healthcare organization.