Price Estimates and Calculation of Patient Responsibility Amounts

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Price Estimates and Calculation of Patient
Responsibility Amounts

• November 6, 2008

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Kathy Lacey Corporate Director, Managed Care
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Florida Statutes Chapter 395.301

• Florida Statutes requires hospitals (prior to
  provision of non-emergency medical services) to
  give its patients written, good-faith estimates
  of reasonably anticipated charges for their
  treatment. Estimates must be provided within
  seven business days after receipt of written
  requests by the patients or their legal
  guardians.
• Orlando Health provides those estimates to our
  patient population currently via the phone for
  inquiries of price shopping and for our
  uninsured patients via a written estimate.

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The Way We Wereor kind of still are!

• For True Self Pay
• Patient calls Self Pay desk to inquire of pricing
  or physicians office attempts to schedule patient
  who is uninsured.
• Self pay Financial Counselor gets procedure
  and/or code to give estimate.
• Estimate is given over the phone for price
  shoppers and a written is mailed if requested.
• For patients being scheduled for a procedure the
  physician office must inform us if the procedure
  is medically urgent or not.

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The Way We Wereor kind of still are!

• For Insured Patients
• Patients do contact us to check on co-pays and
  deductibles for procedures. A Managed Care
  matrix is utilized to give patient estimated
  information over phone.
• For most OP/IP procedures with a managed care
  contract, the information is easily identified on
  our payer matrix.
• Co-insurance and percentage deductibles are our
  biggest pain point.
• Current process goes back to same process as true
  Self Pay with an attempted calculation with data
  received on 271.
• If there is a high deductible (over 2000) then
  we look at the medical urgency and reschedule if
  possible.

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The Way We Areand Getting Stronger!

• New matrix for self pay and managed care being
  utilized.
• Estimate is given over the phone for price
  shoppers and a written is mailed if requested.
• For patients being scheduled for a procedure the
  physician office must inform us if the procedure
  is medically urgent or not.

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The Way We Areand Getting Stronger!
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Estimation Letter Example

• Date of Estimate/Service _______
• ESTIMATE OF PATIENT RESPONSIBILITY
• Dear __________,
• Thank you for choosing Orlando Health, Inc. for
  your healthcare needs and requesting an estimate
  of hospital charges for ___________________ at _
  ____________________.
• Please keep in mind that this estimate is based
  on current information as provided by your
  insurance carrier ___________. The agreement
  your employer has with _____________ and their
  negotiated contract rate with Orlando Health,
  Inc. has determined that the patient
  responsibility would be _________________.
  Your actual amount may exceed this estimate.
• In addition to the hospital fee, you may also
  receive a bill from physicians furnishing
  services to the patient, including but not
  limited to the radiologists, cardiologists,
  pathologists, anesthesiologists, and other
  independent contractors that are not employees or
  agents of Orlando Health, Inc.
• If you have any questions, please contact our
  Pre-Registration department at 321.841.8920 or
  the facilities Patient Business Manager at
  _________________.
• Sincerely,
• _________________________________ _______________
  __________________________________
• Witness Date Patient or Patients Agent /
  Representative Date
• ________________________________________
• Print name of Signature above

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Where We Are Going

• Signed new contract for Benefits (270-271) on
  September 30, 2008.
• Kick off meeting to be held next week to begin
  installation process over next 12 weeks.
• Information will flow real-time to
  pre-registration as well as all Emergency
  Departments.
• Dashboard will house information on patients for
  each registrar.
• Pricing estimator also purchased and will be live
  in 1st quarter of calendar year.
• Estimator will have CDM and Contract information
  to formulate and produce a better calculation to
  give to our patients before, during or after
  their services are complete.

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• Questions?
• Contact information
• craig.pergrem_at_orlandohealth.com