PRMO works with patients to avoid payment surprises

posted October 21st, 2009

DUHS’ Patient Revenue Management Organization (PRMO) is working with patients prior to admission or a medical procedure to avoid “sticker shock” from their out-of-pocket liability for high-dollar services.

The effort, launched about 10 months ago, evaluates on a pre-admission basis the cost of surgeries and outpatient services like cardiac catheterizations, GI procedures and MRIs – procedures that can be expensive for people whose insurance has a high deductible and high coinsurance.

The PRMO financial counseling team contacts the patient’s insurance company to determine benefits before admission and then informs the patient. Since the program began, PRMO has worked with about 15,000 patients.

“If you can imagine yourself as a patient who’s coming in for high-dollar service and you don’t know what your patient liability will be out of pocket, then put yourself in the seat of the person who we contact daily with our team to educate them about their patient liability in advance of service,” says Rodney Williams, PRMO manager of financial counseling.

“We explain to them how their health insurance benefits work and how they apply to the procedure so they can plan financially for their portion,” says Margie Garcia, supervisor of patient financial services.

Patients are pleased with the system, says Vanessa Amos, financial care counselor.

“Rather than get a bill and be shocked with that bill to say, ‘How can I possibly afford this?,’ they know ahead of time,” she says.  “I think it’s a very good process that we’ve laid out for our patients.

Williams agrees, and says the system also has been well-received by the PRMO financial counseling team.

“It’s been a very positive response that they have found to be very rewarding in their job,” he says.






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