No one likes getting an unexpected bill—especially when that bill is for thousands or even tens of thousands. But that’s exactly what has happened to many Americans who have received medical treatment that they thought would be covered by insurance, and instead, they got billed for some or all of it.
Surprise medical billing was an issue before the coronavirus pandemic, and when the disease began to spread through the U.S., both congress and the president took aim at ensuring that people didn’t end up with debt due to the virus.
Regulation to Curtail Surprise Medical Billing
The Trump administration had been working on a proposal to eliminate surprise bills. Congress had also been looking for a solution. They reviewed and considered proposals from insurers recommending rate setting as a solution. These proposals were not accepted because their controversial solution would be to allow insurers and government payers to decide how much they would pay for services, and that would be what providers were allowed to charge.
➤ Medical Billing: Expectations vs. Reality
That approach is clearly unacceptable to medical professionals, but no alternative has been found that works for patients, insurers and healthcare providers.
Executive Order Places a Timeline on a Solution
In September, President Trump issued an executive order called Executive Order on An America-First Healthcare Plan. In reference to surprise medical billing, it states, “The Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services shall maintain and build upon existing actions to ensure consumers have access to meaningful price and quality information prior to the delivery of care.”
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It includes the mandate that, “…the Secretary of Health and Human Services shall work with the Congress to reach a legislative solution by December 31, 2020.” This is followed by, “In the event a legislative solution is not reached by December 31, 2020, the Secretary of Health and Human Services shall take administrative action to prevent a patient from receiving a bill for out-of-pocket expenses that the patient could not have reasonably foreseen.”
This falls under the section on lowering healthcare costs, but interestingly, does not reference modifying the actual costs, rather it requires that patients be informed of the price ahead of time. This will likely become an important part of the service provided by medical billing companies.
Medical Billing Companies Have the Expertise to Provide Cost Information
When a patient schedules medical care, the first thing that happens is checking whether their insurer covers what they need. Normally, if the service is not covered, or the requested provider does not take their insurance, the person will be informed and then chooses to go ahead or seek care elsewhere.
Since medical billing companies are already familiar with the coding that documents what was done, and the bills that explain charges, it would make sense to have them generate the costs that will be shown to patients prior to their acceptance of services.
➤ Are You Getting the Most out of Your Medical Billing system?
Doing so could even cut down on claim denials by entering the actual medical billing codes in advance of services being given and comparing options to make sure all parties are clear on what will be done and what the charges will be.
Also Read: 7 Benefits of Outsourcing Medical Billing
Medcare MSO is an experienced, full-service revenue cycle management (RCM) company. We are committed to providing personalized services to our clients, which means you don’t have to pay for bundled services you don’t want, and when you have questions, you can call and speak to a knowledgeable member of our team. Give us a call at 800-640-6409 with any questions and to find out how we can help you.
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