Case Study
Automated Estimates Increase Accuracy and Transparency
- Customer: Pediatric Hospital
- Challenge: Maximize Epic automation for accurate patient estimates
Results
- 7.2x increase in pre-pay money available to collect
- 3.9x increase in pre-pay money collected within one month
- 100% of estimates meet NSA accuracy thresholds
- 99% of self-pay estimates are auto-generated
- 65% of self-pay estimates are auto-finalized for families
Tegria played a pivotal role in the successful launch of our comprehensive patient estimates program, which harnesses automation to deliver enhanced accuracy and transparency.
DIRECTOR, EPIC REVENUE CYCLE INFORMATION SERVICES
Background and Challenge
As a mature user of Epic, the pediatric hospital recognized the complexity and cross-functional nature of estimates functionality and turned to Tegria for help executing a fully automated patient estimates program. The pediatric hospital knew that providing accurate estimates could help identify families for financial assistance and create the opportunity to collect more prepayments.
Solution
Tegria completed a comprehensive patient estimates engagement, which involved assessing the current functionality and creating an automation roadmap. After the plan was approved, Tegria built a solution to generate accurate estimates for their self-pay and insured patients.
Their deep expertise in patient estimates and patient access enabled us to not only meet all NSA guidelines but also strategically prepare for future legislative changes.
DIRECTOR
The Revenue Cycle + Experience team leveraged a reporting template to analyze the makeup of the estimate templates triggered by scheduled visits.
The solution also entailed:
- Using dynamic frequency reports to validate the appropriate charges with operations
- Documenting key decisions to determine how the system automatically manipulates estimates
- Optimizing Real-Time Eligibility (RTE) benefit mapping to ensure self-pay liability was accurate after insurance
- Developing workqueues and workflows for self-pay encounters that don’t receive an automated estimate to ensure finalization within three days of the scheduled visit to comply with No Surprise Act regulations
- Enhancing Epic Foundation reports and dashboards to strengthen monitoring
Most importantly, our collaboration with Tegria resulted in a solution that has a positive impact on financial performance while keeping patient experience at the forefront.
DIRECTOR
Results
The engagement led to an automated and accurate estimates workflow that is NSA-compliant.
- 800% increase in patient estimates generation
- 99% of self-pay estimates generated with 65% automatically finalized with notification sent to the patient
- 69% of patient estimates are accurate within 5% or $50
- 100% of patient estimates are NSA-compliant
- 7.2x increase in pre-pay money available to collect and 3.9x increase in pre-pay money collected within one month