Case Study

Patient Payment Estimator Significantly Increases Surgery Center’s Upfront Collections

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Center Profile

Located in Blaine, Minn., North Metro Surgery Center is a multi-specialty outpatient surgical facility partnered with local surgeons and AMSURG. The center performs more than 4,400 annual cases specializing in ophthalmology, general surgery, gastroenterology, gynecology, podiatry and ear, nose and throat.

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The Challenge

The U.S. Centers for Disease Control estimates over the past five years, 40 percent of individuals covered by private insurance have been enrolled in high deductible health plans (HDHP), which has resulted in:

  • Deductible costs increasing three times more than premiums, nearly six times more than wages and ten times more than inflation for individuals with single coverage.
  • Increased financial responsibility forcing patients to pay more out of pocket for health services.
 

The surgery center in Blaine, Minn. was struggling to collect the exorbitant increase in copays and deductibles owed by their patients as a result of the rise in these high deductible health plans

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Mark C. Lobanoff, MD

“Prior to AMSURG’s Patient Payment Estimator (PPE), our center collected minimal upfront from the patient. The implementation of the PPE tool has dramatically increased our Center’s net collections year after year. The PPE has allowed us to create a payment estimate for patients to clearly communicate their financial responsibility to be collected prior to surgery.”

North Metro Surgery Center

Unique Solutions

AMSURG reviewed the Center’s financial collection processes and needs to increase upfront collections.

AMSURG recommended Center leadership implement the Patient Payment Estimator application. This automated system uses facility payer contracted rates to provide more accurate patient financial estimates.


Benefits of Patient Payment Estimator

  • Increases accuracy of patients’ financial responsibility at the time of service
  • Improves transparency and patient satisfaction
  • Reduces time staff spends trying to determine specific procedure reimbursement rates
  • Minimizes time spent pursuing patients’ overdue balances
  • Decreases bad debt expense
 

The estimated amounts are communicated to the patient prior to date of service. A financial responsibility form that documents their coinsurance, deductible, co-pay, self-pay fees and outstanding balances will be reviewed and signed by each patient on the day of their procedure and filed in the patient’s chart.

Results

Once the front desk personnel of North Metro Surgery Center began consistently utilizing the Patient Payment Estimator, they improved their upfront collections within a 12-month time frame:

  • 81 percent increase in upfront collections
  • $8.50 more collected per procedure
  • 56.6 percent reduction in bad debt expense
 

By educating patients about their scheduled procedure and health plan coverage, increased financial responsibility has improved transparency, as well as overall patient experience, in support of the no surprise billing guidelines.

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