Medical Billing Imperative

Patient Centered Care – Redesigning Medical Billing

The biggest problem in revenue cycle management for healthcare facilities is unpaid bills for medical services provided.  The acquisition of medical debt leads to a detrimental impact on medical care provided by the healthcare facility and negatively affects the healthcare industry in general.  There is a dire need to redesign the medical billing system to ensure shrinkage of bad debts, increase collections from healthcare consumers and ensure a patient centered healthcare system.

What is the Problem?

According to a survey of 2575 adults, conducted by the Kaiser Family Foundation and the New York Times, 1204 adults claimed that they or someone in their household had problems paying or were unable to pay, their medical bills within the last year.  Most of the surveyed adults were unaware that their healthcare was not covered by their medical insurance.  The largest number of medical billing costs that they had problems paying or were unable to pay, were related to one-time medical events, such as an accident.

There is a need for healthcare plans to work on promoting greater transparency to rectify this widespread medical bills payment issue.  In order to survive financially, the healthcare industry has to make simplicity in healthcare pricing a top priority.  According to the researchers, “The cost of healthcare has long been a concern in the US, on both a national and personal level.  For individuals, this concern plays out most prominently among those who face difficulty paying medical bills or who are unable to pay such bills at all.”

Lack of coverage for people who are uninsured hinder their access to healthcare and leave both the patient and the healthcare facility vulnerable to unpaid medical bills.  However, unpaid medical bills are not a problem with just those who are uninsured.  Insurance protection can be incomplete for a variety of reasons – rising deductibles, out-of-network charges, different forms of cost sharing and the complexity of insurance coverage that can cause consumers to default on their medical bills.  This is further compounded by the fact that most people have modest financial assets to cover their medical expenses.

What is the Solution?

According to the article, ‘Drowning in a Sea of Paperwork: Toward a More Patient-Centered Billing System in the United States’ published in the Annals of Internal Medicine; simplification, consolidation and real time point-of-care information could address the inefficiencies in the medical billing system.  The article focuses on problems related to paperwork in the current health insurance system and potential improvements that could be implemented by providers, health plans, and policymakers.

The number of bills and explanations of benefits (EOBs) that the patients receive; delays in arrival of the bills and EOBs; the format of these bills and EOBs; the costs associated with the system and the complex paperwork all contribute to the shortcomings of this system, according to the authors.  These shortcomings could be addressed by making bills and EOBs simple, in addition to the medical coding and extraneous information.  Consolidating bills and EOBs, with patients receiving one bill per episode of care and the timely distribution are solutions to this problem.  A real time checkout model which will provide patients with an estimated cost initially; and presenting the final bill immediately at the time of discharge/after care, will create a more patient centered system.

According to the authors, “Health care reform efforts have largely focused on improving ‘front-end’ clinical interactions while neglecting ‘back-end’ billing systems.  Redesign of the billing system would relieve a common frustration and is critical for a more patient-centered health care system.”

About the Author:MedConverge

Leave a Comment