4 Ways Patient Call Centers Can Enhance Price Transparency Education

‘How much will this item or service cost me, and why is it more (or less) expensive if I go to a different hospital?’

 In an era of price transparency, it’s a question patients ask frequently, and it may be one they ask more often in the months ahead after a new price transparency compliance deadline takes effect. Why? New requirements arm patients with more information about hospital charges than ever before. However, this information may give rise to questions, and healthcare organizations should have processes in place to provide patient support and education.

 That’s where patient call centers can help. Call center agents may not be able to provide all the answers, but they can certainly field basic questions and connect patients with additional resources, when necessary.

Price transparency: What's new?

The hospital price transparency regulation took effect January 1, 2021, and since then, many healthcare leaders have been working hard to overcome challenges and make their standard charges public. However, beginning July 1, hospitals must not only conform their publicly available machine-readable files to a more precise CMS template; they must also provide patients with additional information, such as:

• Medical codes and diagnosis-related groups (DRG) for items or services linked to standard charges
• General descriptions of each item or service that corresponds to a charge
• Whether the item or service is provided as part of an inpatient admission or outpatient encounter
• Contracting method used to establish the negotiated charge
• How patients should interpret each charge (i.e., as a dollar amount, percentage, or algorithm)

Though well-intentioned, this information can be confusing for patients, and patient call centers may want to prepare for a potential uptick in calls about price transparency data. 

Price transparency: How can patient call centers help?

Here are four steps to healthcare organizations can use to prepare call center agents to help patients understand publicly available price transparency data:

1. Educate call center agents about price transparency. Call center agents should understand the concept of price transparency and be able to explain why this information is now public. Agents should be able to clearly articulate how the information helps patients make informed decisions and that by comparing organizations’ charges, patients can find the most cost-effective care.

2. Create Scripts to help call center agents assist patient in navigating the machine readable file. Scripts should cover the following:

• Definitions of key terms (e.g., medical code, DRG, and negotiated charges)
• How patients can locate estimated charges for their specific health plan with the caveat that the machine-readable file includes estimated—not actual—charges and that their final bill may vary depending on a variety of factors (e.g., their medical condition, length of hospital admission, or unknown complications)
• Why charges may differ from hospital to hospital

3. Incorporate call center agents into an enterprise-wide approach for price transparency. 
When it comes to price transparency, call center agents shouldn’t be the only source of information. Organizations can also use in-office signage, resources posted on the patient portal, and website landing pages like this one that explain key concepts related to price transparency. Include call center agents in conversations about how to raise awareness of price transparency and identify what patients want and need as part of the effort. Call center agents often bring unique insights into patient challenges and can identify meaningful solutions.

4. Empower call center agents with additional resources. Call center agents are not certified medical coders or billers, nor are they financial counselors or patient care advocates. But they should be able to connect patients with one or more of these individuals when more nuanced questions about price transparency arise or when patients seek a more personalized cost estimate. Provide parameters around when and how to refer patients elsewhere so agents can continue to meet and exceed key performance metrics.

Conclusion
Price transparency helps patients shop for the most effective, lowest-cost healthcare available. However, in the pursuit of high-quality, low-cost care, questions will arise. Hospitals that leverage their patient call centers to promote education and support will simultaneously provide a more positive patient financial experience.