Self-Pay: Determining Optimal Care Before the Visit Even Happens

By Tom Schaal, Senior Product Manager, Hospital Revenue Cycle Solution

The Affordable Care Act (ACA) has opened the doors to many new challenges for healthcare organizations, among them is the changed self-pay landscape. While self-pay – defined by both uninsured and self-pay after insurance – has always been a part of the healthcare ecosystem, the shift from uninsured to the high deductibles of many ACA plans has brought self-pay management issues to the surface.

High-deductibles and copayments will leave many patients feeling the burden of out-of-pocket expenses. In just over a decade, the average deductible jumped from $247 to $1,135. Anyone enrolling for bronze level ACA coverage is looking at a $5,081 deductible for individual coverage and the deductible doubles for families. So where does this leave providers? It will ultimately force hospitals to rethink their registration, eligibility, charity screening and collection strategies. Hospitals will need to become proactive when it comes to managing their self-pay risk.

Administrators need to utilize data and predictive analytics to make decisions at the point of registration. Admins can look at a patient’s healthcare credit score and other data points to determine the needs of each patient. Sometimes that information isn’t detailed enough and an organization needs to implement a solution (such as revenue cycle solution) to build a sophisticated patient profile.  

With more intelligent data at their fingertips, providers can make more informed decisions on how to maximize transparency between them and their patients. For example, this data can quickly show a provider that a patient qualifies for charity care and payment assistance programs. Providers can thus avoid inappropriately billing a patient reduce staff time on unnecessary collection efforts and help mitigate bad debt outcomes.

Patients also benefit from intelligent data. For example, a patient access solution allows patients to stay informed about their personal estimated costs before services are rendered, helping them understand the factors contributing to their out-of-pocket liability and avoiding any surprises when they get their bill post-service. This will help patients make informed decisions about their care and increase communication and transparency. More and more technology providers enhance their solutions to include self-pay analytics in a piecemeal effort. If you want to implement a successful program, you should ask yourself the following questions:

Has the technology vendor taken an interest in helping providers manage self-pay before the ACA made it a priority?
Has the technology vendor’s solution evolved over time based on customer feedback and needs?
Do they have a long track record of success working with organizations similar to yours?
Does the solution focus on improving the continuum of care rather than a point solution that doesn’t offer the comprehensive insights you need?

You aren’t alone when navigating this new terrain. Each provider will be seeing an increased emphasis on effective self-pay management and we will work together to optimize the system – leading to greater efficiencies and increased patient satisfaction. 


MedeAnalytics is a leader in healthcare analytics, providing innovative solutions that enable measurable impact for healthcare payers and providers. With the most advanced data orchestration in healthcare, payers and providers count on us to deliver actionable insights that improve financial, operational, and clinical outcomes. To date, we’ve helped uncover millions of dollars in savings annually.

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