At A Glance
To meet evolving price transparency regulations, University of Tennessee Medical Center (UTMC) partnered with Experian Health to implement Patient Estimates. This integrated solution helped their healthcare organization maintain compliance, increase estimate delivery and empower patients with clearer cost breakdowns.
In this article…
“Experian Health helped us meet the compliance of the Price Transparency Rule. Without it, we would have been subject to large fines.”
— Marianna Ross, Manager of Customer Services and Financial Counseling at UTMC
Challenge
Before 2020, UTMC, a leading Level 1 Trauma Center that serves patients across three states, relied on a manual, time-consuming patient estimate process. But when the Centers for Medicare & Medicaid Services (CMS) issued its Hospital Price Transparency Rule, UTMC’s patient access leaders knew their existing processes couldn’t keep up with new price transparency regulations.
UTMC’s financial counselors were still manually extracting charges and CPT codes using historical claims in an internal reporting system. Without a digital system in place, the team was struggling to do its job efficiently, and patients weren’t always able to get information required by the ruling.
To avoid compliance penalties, UTMC needed a streamlined estimate process with better tools and the necessary integration to provide clear, upfront price estimates. The new process also needed to be reliable under a potential CMS audit and simple for staff to use while allowing for future scalability.
Solution
To ensure the hospital could keep up with changing price transparency regulations, UTMC partnered with Experian Health and implemented Patient Estimates. Instead of tedious manual patient estimate processes, Patient Estimates pulls information from the hospital’s chargemaster, payer contracts (integrating with Experian Health’s Contract Manager), claims history and real-time eligibility data.
Patient Estimates gave staff confidence to generate accurate patient estimates, while patients felt empowered to read a clear, detailed estimate specific to their procedure. Plus, its built-in reporting meant UTMC could easily demonstrate its compliance with the new Hospital Price Transparency Rule.
And after a successful implementation and fulfilling all 2021 Hospital Price Transparency Rule mandates, UTMC continued working with Experian Health to develop a robust and unified patient payment strategy. In addition to Patient Estimates, the following Experian Health solutions were implemented:
- Self-Service Patient Estimates to enable patients to generate either a self-pay estimate or price estimates for services using their current insurance information.
- PaymentSafe® to support pre-service and secure point-of-service transactions.
- Patient Financial Advisor to deliver text estimates to patients’ mobile phones with the option to pay.
The timing of the new processes couldn’t have been better. In 2024, UTMC’s Board set a strategic goal to increase the number of estimates delivered within the year. With Patient Estimates, Self-Service Patient Estimates, PaymentSafe and Patient Financial Advisor working together, the team didn’t just meet the goal — they exceeded it by 42.77%.
Outcome
With a fully integrated system now in place, staff and patients both get access to accurate estimated cost breakdowns—and estimates are sent a few days earlier than UTMC’s previous process. With robust cost breakdowns and multiple payment options, staff are empowered to engage in more compassionate financial conversations and patients have more time to consider the cost of care and make financial arrangements.
According to Ross, “Estimates and payments are complicated to unravel for many of our patients. And patients are scared and nervous about procedures. It is helpful to have a simple, clear breakdown of costs to help guide these conversations.”
With Experian Health’s Patient Estimates, Self-Service Patient Estimates, PaymentSafe and Patient Financial Advisor working together, UTMC delivered big results in compliance and the number of estimates it issues.
Ross encourages other hospitals going through similar transitions to first invest in their contract data—and that includes finding the right technology partners. She notes that partnering with Experian Health was critical to the success of UTMC’s new patient payment system. “Experian Health evolved with us as our needs progressed and changed to ensure we received the most from the products.” Ross also reminds organizations who are making the switch to educate patients: “This is a cultural change, not just a system change. And like all change, it takes time.”
Learn how price transparency solutions from Experian Health can help healthcare organizations stay compliant with current regulations and help patients better understand their costs.
