Q: How do you estimate total patient responsibility? I’ve heard that it is 17 percent of adjusted net patient revenues, but is this accurate?
A: While I wish I could say “yes,” the calculation of patient responsibility is much more complex. It is dependent on the insurance or payer plan design, where the patient may be in their deductible, and the clinical treatment being considered. Emerging approaches for estimating are to:
- Implement a patient estimation system that connects to plan systems and your contract infrastructure
- Develop a rough Excel spreadsheet of common averages by plan and by procedure
The later approach is crude, but better than nothing.
Steve Levin, co-founder, Connance, answered this question.
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