hospital billing

Does the United States Need a National Hospital Billing Data Set?

Patients’ experience in hospitals and hospital billing can vary significantly, even if two hospitals are just a few miles away from each other. In essence, the American patient has no idea what their financial experience will be when they step into the hospital setting – they’re rolling the dice.

But a dedicated organization is trying to provide some transparency around the hospital billing and financial experience. The Lown Institute has launched a two-year long endeavor to look into hospital revenue cycle practices around some of the most controversial hospital behaviors, including sending patients to collections, denying care, and filing lawsuits against patients with unpaid bills [1].

It is a logical extension of recent efforts around price transparency and pushback on “surprise billing” practices. Starting in 2021, hospitals were mandated to post chargemaster prices, payer negotiated prices, and discounted cash prices for the public. (Compliance has been spotty, with only a third of hospitals meeting requirements as of 2023 [2].)

This could be a very fruitful project since hospital pricing can vary significantly. Recent studies have illuminated just how much prices vary across the country [3]. Urban hospitals average prices 14% lower than rural, teaching hospitals have prices 3% higher than nonteaching, and nonprofit and for-profit hospitals price 9% and 39% higher than government-owned hospitals, respectively. Hospital practices can also directly impact patient lives. Hospital billing decisions can leave patients with damaged credit scores and increase financial hardship, and this can vary by condition. “Financial toxicity”, for example, has been found to be worse for cancer patients [4].

I can see this being both challenging and beneficial for hospitals. If the patient experience at least has an informal standardization, hospital billing and hospital coding strategy goals are simplified. Best practices and benchmarking would be much easier if hospital leadership had insights into their peers’ decisions. This also means hospital leadership will have more direction when establishing billing standards, creating debt collection practices, and working with outside vendors and revenue cycle management services.

The report for this project won’t be issued until 2025, but I’m looking forward to it. It will cover 2,500 hospitals and I think marks a new future of hospital billing standards for providers across the nation.

 

Hemant Apte, Chief Executive Officer in

Hemant Apte, Founder & Chief Executive Officer of 3Gen Consulting, is a seasoned executive leader with deep domain expertise in US healthcare management practices. He founded 3Gen Consulting in 2006 and has been instrumental in offering thought leadership to his clients and providing services and solutions that are unique in the market.

Revenue Cycle Expertise Gaps

Revenue Cycle Expertise Gaps Might Require Looking Externally

Revenue cycle management has grown to an unmatched level of complexity in recent years. For most organizations, this has meant increased needs for training and improved hiring processes – but is it possible there’s a limit to the effectiveness of these tactics?

If you take a close look at the requirements of many revenue cycle roles, you’ll likely find something interesting. A select few are so complex, that they require looking outside the organization for expertise to access a higher level of performance in revenue cycle management services. These are typically positions that have

Medical Coding Audit Prevention for 2024

Medical Coding Audit Prevention for 2024

With Q4 of 2023 coming around the corner, it’s time to start looking at plans for 2024. It might not seem like it should make your short list of priorities, but medical coding audits should be on the mind of your leadership team today – specifically looking for ways to get in front of them. 

Healthcare providers will be in a much better position next year if they take the remainder of 2023 to step back, look for current issues, and devise ways to prevent and respond.

The Future of Medical Coding Isn’t AI – It’s Collaboration

The Future of Medical Coding Isn’t AI – It’s Collaboration

One of my greatest concerns around AI isn’t that it’s going to one day go rogue and cause massive issues for some unfortunate provider. I believe the chances of that are slim to none.

My deepest concern is potential missed opportunities. This is because AI promises so much to the healthcare revenue cycle – increase in quality and accuracy, efficient medical coding workflows, and, in the end, a profitable organization. And while that might be possible down the line, for

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