HFMA task force releases best practices for resolving patient medical bills

The Association of Credit and Collection Professionals and the Healthcare Financial Management Association's Accounts Receivable Resolution Task Force reconvened this year to update best practices for resolving patient medical bills.

The updates, created in response to the COVID-19 pandemic, focus on patient education and communication.

"This year was a critical time to revisit and update these best practices on behalf of healthcare providers and accounts receivable management companies with the goal to help consumers resolve and understand their medical bills," said Mark Neeb, CEO of the ACA.

WHAT'S THE IMPACT?

The first aspect of the updated framework is patient-friendly billing. HFMA has a set of principles that help guide this idea, including clear and understandable language, concise bills with only the necessary information, accurate information regarding the patient's financial responsibility, and processes focused around the patient's needs.

Next is effective communication between providers and patients at every stage of the process. This helps patients become more engaged in their healthcare and gives them a better understanding of how to resolve their outstanding accounts, according to the report.

HFMA recommends that providers assume responsibility for engaging in these conversations long before the post-discharge account resolution process. For nonemergency services the conversations should begin before the procedure, and for emergency services they should occur before discharge, according to the framework.

Within their communications with patients, providers should educate patients on the account resolution process, the report said. This can look like a discussion about how patients can qualify for third-party-payer coverage or different ways that patients can pay their bills.

Beyond traditional modes of communication, the task force encourages the use of alternative strategies such as informational signage and pamphlets in the registration area, explanatory YouTube videos, and chatbots on facility websites.

Above all else, giving patients price estimates of the medical procedure is crucial in facilitating a discussion about the patient's financial obligation, the report said.

For insured patients, the estimate should include the member's expected out-of-pocket expenses, based on their current deductible status, along with co-payment and coinsurance information, which can be provided by their health plan.

Uninsured patients should be provided price information resources from the hospital, as well as alternatives for sharing their healthcare expenses such as insurance options and financial assistance, according to the report.

In addition to following the best practices shared in the report, HFMA suggests that providers regularly survey their patients to assess their performance in assisting the resolution of medical accounts.

THE LARGER TREND

The task force was originally created in 2014 to establish best practices for the fair resolution of patients' medical bills. Members of the task force included providers, patient advocates, collections agencies and credit bureaus.

The biggest barrier to a positive patient financial experience is a lack of understanding around pricing, insurance coverage and the complexity of medical bills, according to a study by WayStar. The research found that a quarter of patients find pricing too complicated to understand.

This is especially true among Medicare beneficiaries, with more than two-thirds saying their insurance is confusing and difficult to understand in a survey conducted by MedicareAdvantage.com. The same survey found that a majority of beneficiaries couldn't correctly define basic insurance terms such as "deductible" and "coinsurance." 

ON THE RECORD

"We know medical debt sometimes comes with added challenges and uncertainty, and it is the mission of the accounts receivable management industry and its health care provider partners through these best practices to work together to offer solutions, education and guidance," ACA's CEO Mark Neeb said.

Twitter: @HackettMallory
Email the writer: mhackett@himss.org