Introduction

Patient Bill Estimates is a feature, powered by the Patient Bill Estimates AI Agent, that automates generating an estimate of patient's out-of-pocket costs (patient responsibility) for expected healthcare services before they are created.

In Oracle Health Patient Administration (PAS), provider staff can use the new Patient Bill Estimates feature to automatically generate patient bill estimates for scheduled appointments using the new Patient Bill Estimates AI Agent. This feature allows provider staff to review estimate details, modify expected services, and generate a revised estimate before approving it. It also allows provider staff to generate a PDF document of the estimate with a standard disclaimer.

The system uses the information outlined below for the patient and the expected services to calculate the patient's estimate out-of-pocket costs (patient responsibility). The AI agent applies the payer contracted rates or self-pay discounts and generates the detailed estimates, including an itemized list of expected services and breakdown of patient responsibility as output.

• Demographics
• Insurance eligibility
• Coverage
• Benefit details
• Scheduled appointment and encounter details
• Provider's payer contract data
• Expected services (procedures, tests, and so on) identified using historical billing/claims patterns and clinical context

The Patient Bill Estimates service provides the following benefits:

• Patient satisfaction scores can improve as transparent billing estimates help patients understand their financial responsibility upfront.
• Increase patient collections by providing the patient responsibility and collecting payment at the time of registration or scheduling.

Note:

In a future release, the Patient Bill Estimates feature can be integrated in other workflows.