New AI Token Model Opens Door to Advanced Registration and Hospital Patient Financial Management

CURRENT PATIENT REGISTRATION AND FINANCIAL LIABILITY REQUIREMENTS

In the Emergency Department, to comply with EMTALA regulations, the current patient registration process captures the patient’s name, date of birth, and social security number prior to clinical triage. Following triage, staff members aim to gather additional demographic and insurance information, typically by scanning the patient’s driver’s license and insurance card. However, this scanning process only captures and stores images in the EMR, requiring the hospital’s billing staff to later transcribe these images and manually enter the data into the EMR system. Delaying the capture of discrete data can hinder efforts to secure financial liability from the patient for the treatment provided. If the patient departs without securing their financial liability, the collectability of that receivable typically declines by 90%, a common metric for most hospitals. New AI tools have the potential to mitigate this issue entirely.

This differs from collecting co-pays at service time, which is usually the main patient liability for clinical practices. Patient responsibility often encompasses larger co-pays, co-insurance, deductibles, and higher balances due post-insurance billing. Consequently, failing to secure and collect this additional patient liability results in greater financial losses. Using new AI tools can prevent these losses entirely.

VestaPay DBA-APP:

The effective strategy for securing 100% of the patient’s liability is to do so at the time of service while the patient is still present or within one or two days of discharge. The key challenge is how to secure 100% of this liability at the time of service when the patient’s liability is not fully known. Additionally, affordability is a concern. With rising healthcare costs and patients bearing a greater portion of their liability, it is impractical to expect patients to pay 100% of their liability at the time of service. A more flexible solution is required.

VestaCare has addressed this challenge with the introduction of a new Dynamic Balance Adjusting AutoPay Plan (DBA-APP) system. Unlike typical payment plan systems where the final balance is required at the time the payment plan is set up, the VestaPay DBA-APP system works with non-final balances. This allows patients to schedule their payments for their initial estimated balance, at the time of service, in a manner that is affordable to their budgets. It is then automatically adjusted over time to reconcile with changes to the patient’s final balance as future adjustments are applied.

For example, assume a patient has an emergency department visit estimated to cost $1,000 at the time of service. Most patients cannot afford to pay this amount out of pocket at the time of service. The hospital offers the patient the option to use the VestaPay DBA-APP with monthly payments set at $100.00. This payment amount will be processed on a day of the month suitable to the patient’s cash flow and budget. The first payment starts at the time of service, so the hospital collects $100.00 immediately. Then on the same day of months 2 through 10, similar payments are processed with the patient receiving a 10-day advance notification of each pending payment. By the third payment, the hospital has collected 30% of the $1,000.00 estimated patient balance owed, compared to the typical 9%. If the final Explanation of Benefits (EOB) is received by the hospital in month 3 and the final balance is $1,400.00 due to charges not identified initially, the DBA-APP notifies the patient of the new balance and adds the additional $400.00 to the DBA-APP, extending the plan by four months. This means four more payments are automatically applied to the 10-payment DBA-APP schedule. The hospital secures additional patient liability without requiring further balance billing actions. The patient’s plan extends by four months but retains the same monthly payment.

The DBA-APP process is automated within the VestaPay payment management system and the hospital’s electronic medical records (EMR) system, keeping the patient’s accounts synchronized without intervention from the hospital’s accounting department. This automation allows hospital staff to focus on other patient support initiatives, such as advanced estimating, performing insurance discoveries, and remote connectivity with other staff to enhance resource utilization across the hospitals. These capabilities are discussed in the next VestaPay white paper.

Financial Results:

Patient satisfaction has increased, as demonstrated by fewer delays in registering patients and positive feedback. Financially, our reference hospital saw patient revenues rise from an average collection rate of 9% to 22%. Additionally, over 92% of patient balances managed through the DBA-APP system have been collected without involving collection agencies. This performance is also evident in the steady increase of recurring revenue collected by the hospital, which has been growing monthly over the five-year period since the installation of the system.