Billing out of whack,’ focus groups believe 

Consumers believe there is gaming going on between the provider and the payer when it comes to billing, and that they are caught in the middle. Those are among the concerns expressed by participants in focus groups conducted as part of the Patient Friendly Billing Project of the Westchester, IL-based Healthcare Financial Management Association (HFMA) and the American Hospital Association (AHA). The project aims to help health care providers convey bills — or, more precisely, "a series of financial and other communications" — to patients and their families that are clear, correct, concise, and patient-friendly, says Richard L. Clarke, HFMA president and CEO. The first phase of the project, he adds, will focus on hospitals and health systems but eventually, the focus will broaden to medical practices and payer financial communications. 

Problem is in the system’ 

There is the general sense among consumers, Clarke notes, that the "system" is fundamentally out of whack. "Multiple bills from multiple providers, interacting with one or more payers — all using different forms, terminology, and approaches — creates a system that is almost impossible to track and understand." While short-term fixes can be made to improve patient financial communications, the main question, he says, is how the system can be changed to get the consumer out of the middle. "To change the system," Clarke points out, "will require the interaction, cooperation, and agreement of providers, payers, government, and employers — a daunting task." The Patient-Friendly Billing Project, he adds, recommends a multidisciplined approach that will include these elements: 

• a process that captures and summarizes bills from all providers, and automatically matches them with all payments; 

• a consolidated communication that clearly identifies all the services that were provided for an episode or episodes of care, the coverage of that care by health or other insurance companies, expected health insurance payments, and what is due from the consumer; 

• a single point of contact for the consumer, by telephone or web site, designed to respond to inquiries, complaints, or concerns about benefits, coverage, and payments; 

• an appeals process to handle disputes that consumers may have about eligibility, coverage, charges, and payments. Also under this ideal system, Clarke says, payments by consumers would be made to a single source, and automatically distributed to providers and suppliers involved in the episode of care. [Editor’s note: For more information about the Patient-Friendly Billing Project, call (800) 252-HFMA, ext. 3.]