The face of healthcare is changing. Patients are carrying more of a financial burden for their care, creating more consumerism. They expect two things from their providers: quality healthcare and price transparency. It’s no longer acceptable for many patients to not know what they’re getting into when receiving medical care. If they don’t know their costs upfront, they likely will go elsewhere to a provider offering price estimation, patient payment solutions, and additional digital tools for engagement.
Lori Wellborn, Account Manager for ImagineSoftware
Caroline Smith, Senior Marketing Campaign Specialist for ImagineSoftware
Stressful Patient Billing Surprises
Opening the mail only to find an unexpected medical bill can be very stressful. It’s even worse when the amount of the bill is much higher than expected, especially for emergency care. That’s one of the reasons what’s referred to as “surprise billing” has become such a hot-button issue for both patients and politicians over the past few years.
The average surprise charge for an emergency department visit is approximately $600, but some patients have received bills larger than $100,000 from out-of-network providers. Ambulances are the biggest source of unexpected medical bills — an estimated 71 percent of ambulance provider bills are out-of-network, resulting in average surprise bills of $450 for ground transportation and $21,698 for air transportation.
These astronomical costs along with a lack of price transparency often deter patients, especially those without health insurance, from receiving care. Some patients often receive medical care without knowing the exact price, even though they face high and varying out-of-pocket fees for their care. Others never stop to question whether they were charged correctly or whether their insurance was ever billed.
Even patients who have health insurance often struggle to pay their medical bills. Almost 80 million Americans either aren’t able to pay those bills or are paying off medical debt. Two-thirds of individuals who file for bankruptcy cite medical issues as a key contributor to their financial downfall.
Surprise Billing Legislation
Data from PatientsRightsAdvocate.org shows that 85 percent of Americans believe that cutting costs and improving quality by making healthcare prices, quality metrics prices, quality metrics and outcomes more transparent should be a priority for lawmakers. Lawmakers have listened. Legislation over the past few years designed to curb surprise medical bills and spur price transparency include the Hospital Price Transparency Rule, the Transparency in Coverage Final Rule and the No Surprises Act.
The Hospital Price Transparency Rule, which effect on January 1, 2021, requires each hospital operating in the United States to provide clear, accessible pricing information online about the items and services they provide in two ways: as a comprehensive machine-readable file with all items and services or in a display of shoppable services in a consumer-friendly format. Many hospitals haven’t yet achieved compliance with the rule, though. As of February 2022, only 14 percent of hospitals had met compliance with the rule.
The Transparency in Coverage Final Rule was issued in October 2020 as part of the Consolidated Appropriations Act. In effect since July 1, 2022, it requires most group health plans and health insurance issuers in the group and individual market to disclose price and cost-sharing information to participants, beneficiaries and enrollees.The first surprise billing legislation passed on the federal level is the bipartisan No Surprises Act, which went into effect on January 1, 2022. It prohibits out-of-network providers from billing patients more than in-network cost-sharing amounts for the following:
- All out-of-network emergency facility and professional services
- Post-stabilization care at out-of-network facilities until such time that a patient can be safely transferred to a different facility
- Air ambulance transports, whether emergency or non-emergency in nature
- Out-of-network services delivered at or ordered from an in-network facility unless the provider follows the notice and consent process
For medical billing companies, the most important part of the act may be the independent dispute resolution process, which requires providers to work with payers to settle on fair prices. If these two parties don’t reach a voluntary agreement in a 30-day negotiation period, an arbitrator will be selected to pick one of the submitted amounts.
The Perks of a Price Estimator
Healthcare providers know that patients confused about their medical bills are more reluctant to pay them. However, if a provider can take the time to provide more clarity and transparency around what the patient owes, it will often result in a better experience. It also builds trust between providers and patients, thereby improving patient loyalty and retention and reducing revenue leakage.
Also, by giving patients an estimate of what they owe, fewer accounts will be sent to collection agencies, and providers will be writing off less bad debt. Along with offering payment plans, this enables provider employees to spend time doing more proactive and productive tasks.
At ImagineSoftware, our ImagineSimplicity™ solution provides patients with a clearer view of their financial responsibility. Available in a standalone version or integrated with partner solutions for healthcare providers, it increases collections at point-of-service through more timely and transparent pricing. Request a demo to learn more!