Challenge: Lack of estimates left patients guessing and put revenue at risk
Many hospitals view patient estimates as just another compliance checkbox. However, regulatory scrutiny by the Centers for Medicare and Medicaid Services (CMS) is intensifying, so healthcare providers can’t afford to “hope it’s right.” Regulatory fines and reputational damage aren’t the only risks. Inaccurate or hard-to-access estimates can erode patient trust, drag down pre-service collections and leave staff drowning in manual work.
“Without a clear understanding of their financial responsibility beforehand, even a successful surgery can be overshadowed by the stress of an unexpected bill. By providing accurate estimates upfront, we help ensure that financial concerns don’t interfere with their recovery.”
Morgan Jones, Patient Services Manager, Avita Health System
Avita Health System wanted to help their patients better understand their financial obligations, improve financial transparency and reduce billing surprises. However, they lacked the tools to provide pre-service cost estimates. There were also gaps in data quality, which made it difficult to figure out what patients were likely to owe. Patients felt frustrated when their bills arrived, and Avita’s pre-service collections were inconsistent, averaging only 1.5% collected per estimate.
Avita needed a partner, a more consistent process and better data to generate accurate patient estimates.
Solution: Accurate estimates and training to boost staff confidence
Avita partnered with Experian Health, a trusted partner, to implement Patient Estimates. This solution uses chargemaster data, payer contracts, claims history and real-time eligibility data to calculate accurate estimates that staff could confidently explain. Avita also integrated Self-Service Patient Estimates into its existing workflow, to offer over 300 shoppable services.
“Patient Estimates breaks down costs at the benefit level, allowing our staff to clearly see what is covered by coinsurance or deductible and how much remains. They can confidently explain the estimate to patients in a way that’s easy to understand.”
Morgan Jones, Patient Services Manager, Avita Health System
Direct access to Experian Health’s support team—and their proactive responsiveness—also helped Avita make ongoing improvements. When payer rules changed at the start of the year, Experian Health’s team stepped in to adjust the logic and resolve accuracy issues.
Avita also implemented Experian Health’s Power Reporting tool, which allows them to review hospital-level performance, reconcile accounts and investigate coding mismatches.
“We routinely review all that data to reconcile and see where the underlying problems are so we can get even better with our accuracy.”
Nathan Strome, Revenue Integrity Manager, Avita Health System
But Avita saw its biggest gains from staff training on pre-service collections best practices and its point-of-service collections. With extra support and training, Avita’s staff was able to translate the estimates into confident financial conversations and payment requests.
Results
| Patient Estimates Results: |
| – 47% increase in pre-service collections realized |
| – 169% increase in point-of-service cash collections attained |
| – 95% of scheduled patients now receive a pre-service estimate |
| – 93% accuracy is achieved in estimating what patients owe |
Since implementing Experian Health’s Patient Estimates, Avita now provides 95% of scheduled patients and 80% of walk-in patients with a clear estimate before care, at 93% accuracy. With fewer billing surprises, patients have a better experience and Avita’s pre-service collections are up nearly 50% from $2.9 million to $4.28 million over a two-year period. Staff are also collecting a greater share of patient responsibility earlier, with a minimum of 11% collected upfront compared to 1.5% before training.
“We weren’t willing to sacrifice accuracy.”
Angela Murphy, Senior Revenue Cycle Coordinator, Avita Health System
But for Avita, prioritizing data accuracy remains a non-negotiable, especially as CMS oversight leaves little room for error. “If estimates aren’t accurate, no amount of training and scripting will make a difference,” says Murphy. “Don’t assume your build is perfect. Audit your work and don’t hesitate to request changes when needed.”
Learn how Experian Health’s price transparency solutions help healthcare organizations stay compliant with current regulations and help patients better understand their costs.
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