How Better Transparency Can Bolster Medical Billing

April 26, 2016 by Antonio Arias, MBA, CHBME

Topics: Practice Management, Medical Billing Company

From inside the healthcare industry, providers and their medical billing teams have a framework for understanding of how the billing process works. From outside, however, it’s an entirely different story. Both insured and uninsured patients face huge challenges navigating the business side of the American healthcare system – in part because few have the luxury of thinking about the “business side” when their need for care arises.

Many patients only pursue treatment when facing emergencies, illnesses, or recurring healthcare issues, making it hard for them to think ahead to budgeting and planning for potential costs. Even as the industry pushes for a greater focus on primary care, most Americans’ engagement with the healthcare system is reactive – either to their physical needs or their doctors’ orders.

And when their doctors tell them they need a procedure, patients undertake it – often without asking many questions – and hope for a (somewhat) reasonable bill. But what counts as “reasonable” varies too much from inside the healthcare system for there to be any standard for what to expect: In 2013, the New York Times reported on how the cost of a colonoscopy varied across the country to a stunning degree – ranging from around $1,900 in Baltimore up to more than $8,500 in New York City.

And even if they ask questions about costs in advance, many patients are out of luck when it comes to earning answers. Despite advances among some individual medical practices, urgent care centers, and accountable care organizations, accessing pricing information remains an incredible challenge across the healthcare industry at large. As the Times noted in 2013, many doctors often do not even know the costs of the tests and procedures they prescribe.

Insurance complicates the situation even further. A patient without it knows to hold his or her breath for a (likely) hefty ER bill or care-center statement any time they receive care. Patients with insurance often don’t think they’ll be responsible for a big sum, but lack the tools and resources to calculate what they’re in for. As healthcare professionals, we know how problematic this overall situation is... but we often fail to consider its impact on our own billing outcomes.

Case in Point: The blogs and media outlets serving the medical community – including this one – provide a wealth of insights and best practices to providers on how to boost medical billing performance. We tout the inherent value of technology, of improved process management and efficiency, and of medical billing outsourcing for boosting billing-related performance indicators. We advise on keeping patients out of collections, and on investing in staff training to encourage team members to collect payments in-office.

All of those things are valuable, impactful efforts that can absolutely make an impact on providers’ bottom lines. But ultimately, improving billing results long-term requires improving billing itself – it requires making the healthcare system transparent enough that it can be truly understood by patients throughout the care-delivery, follow-up, and payment cycles. There will always be non-paying patients and problematic payers, but bills that patients know to expect (and can prepare themselves for in advance) will almost always be paid – and that’s the real best practice for bolstering the revenue cycle at large.

Your practice can only do so much, but becoming a beacon of transparency in your own community is the best place to start. Make sure your doctors understand the costs of all commonly ordered procedures, and encourage them to be honest about them with patients (and to discuss lower-cost alternatives when possible). Create rate sheets for self-paying patients, and list out common percentages “paid by insurer” to help your covered customers know approximately what they’re in for, every time. Hire a medical billing advocate to help your patients get more aware of costs and more involved in the billing experience.

Ultimately, better serving your patients will result in better billing performance – and providing price transparency is one of the best ways to do that.

Are you interested in learning more revenue cycle management tips? Visit our blog! 

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