02 — Capability · BC-1810.50
Patient Financial Counseling
Tell patients before care what they are likely to owe and how they can pay or get help, and clear each account financially before scheduled services. Statements, payment plans and collections after the visit are patient billing.
- Financial Clearance
- Financial Counseling
- Financial Navigation
In scope
- Good-faith and patient cost estimates for planned services
- Financial clearance of scheduled accounts and point-of-service collections
- Screening for financial assistance and charity care eligibility
- Helping uninsured patients apply for public or marketplace coverage
Out of scope
- Statements, payment plans and collection of balances after the visit (see BC-1840.50)
- Publishing the organization's standard charges (see BC-1840.10)
- Customer credit limits and credit risk in general (see BC-250.20)
Realized by · 2
- Oracle Health · Oracle Health Paymentpartial via BC-1810.50.30
- MEDITECH Expanse · Revenue Cyclecore via BC-1810.50.10
Used in · 2
Build it · 0
- Nothing in the library points here yet.
Decomposes into · 5
- BC-1810.50.10Patient Cost EstimatesGive patients an estimate of their share of the cost of a planned service, built from their benefits, the payer contract and the expected charges, and give uninsured and self-pay patients a good faith estimate, in the form and time the rules require.
- BC-1810.50.20Financial Clearance ReviewConfirm before a scheduled service that coverage, authorization and the patient's payment arrangement are in place, and escalate or reschedule accounts that are not cleared.
- BC-1810.50.30Point-of-Service CollectionsCollect copays, deductibles and deposits at scheduling, check-in or discharge, and record each payment against the right account.
- BC-1810.50.40Financial Assistance ScreeningScreen patients against the organization's financial assistance policy, collect what an application needs, and record the discount the patient qualifies for.
- BC-1810.50.50Coverage Enrollment AssistanceHelp uninsured and underinsured patients apply for public programs or marketplace coverage they may qualify for, and follow each application to a decision.