Recondo, Epic Systems collaborate to improve price transparency, patient collections with new service

A historic rise in high-deductible health insurance plans has US hospitals struggling to give newly price-conscious patients an accurate estimate of their share of healthcare costs. At the same time, with an increasing share of their revenue dependent on patients, hospitals are accelerating efforts to collect patient payments up front to prevent bad debts.

The dual focus on price transparency and patient collections is driving a search for new financial technologies to support this "consumerization" of healthcare. It's a tall order for an industry long accustomed to dealing only with commercial and government payers.

Now Recondo Technology (Recondo), a leading provider of cloud-based revenue cycle connectivity and applications, has moved to solve the problem through a first-of-its-kind collaboration with Epic Systems, one of the nation's premier providers of electronic health records (EHR).

At the request of a large multi-state health system that uses Epic, the two companies integrated Recondo's BenefitPlus™ patient estimation tool with the Epic Benefit Collector tool. Both tools are now in use across the health system's nearly three dozen acute care hospitals and in its clinics for several thousand physicians, enabling patient access staff to generate estimates of patient financial responsibility with unprecedented accuracy.

Using the new tool, the health system has increased point-of-service (POS) collections by 12 percent over 12 months, representing several million net-new dollars falling to the bottom line.

"With the rise in self-pay and high-deductibles, hospitals need to be able to accurately estimate patient financial responsibility so they can attract the growing number of patients who are price shopping and also reduce the likelihood of bad debt by collecting more up front," said Jay Deady, CEO of Recondo. "We're thankful that Epic was willing to work with us to quickly meet the requirements of our joint customer. Together, we've built a powerfully fast and accurate replacement for what is otherwise a highly manual process, and one that hospitals can no longer afford to overlook."

How It Works

The combined Epic and Recondo solution generates accurate patient estimates without forcing providers to take on the onerous and continuous task of custom rules development. Epic's Benefit Collector verifies a patient's insurance eligibility after registration via an electronic query sent to the payer through a claims clearinghouse. The Epic tool then runs the payer's response through a set of benefit collection rules to identify the benefits needed for a patient estimate.

In most cases, however, the payer's response does not include the specific Service Type Codes (STC) needed to match the insurance benefit to the patient's clinical procedure. As a result, provider staff must analyze the payer data down to the plan level and specific STCs – a time-consuming task that hospitals often lack the resources to undertake, making it impossible to generate accurate estimates for most patients.

Recondo's BenefitsPlus™ solution automates that resource-intensive step, working in the background to complete the estimation process by adding built-in logic matching procedures with STCs. The process is enabled by Recondo's patentedⁱ Reconbot® technology, which takes the revenue cycle to the next level by automatically querying payer websites and then retrieving, normalizing and presenting information critical to the patient access and claims follow-up process.

With the combined solutions, end-users can now generate highly accurate estimates of patient financial responsibility for all procedures, without ever leaving the Epic system.

SOURCE Recondo