Practice Management News

HHS Unveils Simpler Medical Billing Process Challenge Winners

HHS tapped two companies for developing simpler medical billing approaches that are more patient-centered and easier to understand.

By Jacqueline LaPointe

- The Department of Health and Human Services (HHS) recently announced two winners of a medical billing competition that sought a simpler patient payment collections experience.

HHS announced two winners of a medical billing challenge that sought to improve the patient payment collections experience

The “A Bill You Can Understand” competition, sponsored by AARP and administered by Mad*Pow, was designed to address major patient challenges with the medical billing system, HHS explained. Patients oftentimes complain that medical bills are confusing, especially since patients may receive multiple bills from different providers for the same healthcare encounter. The bills also add to the confusion because they all look different and use healthcare jargon.

Through the competition, which was launched in May of 2016, HHS challenged healthcare stakeholders to simplify payment collections for patients and make the medical billing process more patient-centered.

“One of our priorities is to put patients at the center of their own healthcare,” said Sylvia Mathews Burwell, HHS Secretary. “Helping Americans understand their medical bills empowers them to take more control of their health, and that’s a step in the right direction for our entire healthcare system.”

After reviewing over 80 submissions, HHS awarded two prizes for a new medical bill that is easier for patients to understand and a new medical billing approach that allows patients to better see and participate in the process.

HHS awarded the first prize to California-based RadNet for its medical bill design that was the easy to understand. Developers at the radiology solutions organization created a concise and adaptable bill that aligns with a patient’s experience, including options for uninsured individuals and for making past due payments.

The federal department selected RadNet’s medical bill format because it clearly presented patient payments due, payment options, and insurance information. The bill explained patient payments in plain language rather than healthcare jargon and used colored segments on the page or screen to make it easier to locate and read billing information.

According to the competition’s website, the design challenge advisory panel liked the design’s “relationship between a simple paper bill and a more detailed explanation online as it allows patient to get as much or as little information as s/he sees fit.”

Sequence, a brand communication and digital solutions company from California, received the second prize for developing a simpler medical billing approach. The company created “Clarify,” an online- and mobile-based system that applies a retail model of consumer behavior to patient payment collections. The medical billing service allows patients to browse through healthcare services as well as compare services and prices. Patients can also choose how they intend to pay their medical bills.

“Clarify” has the potential to strengthen relationships between healthcare consumers, providers, and payers, HHS stated, by updating, automating, and personalizing the medical billing system.

“This truly meets modern consumer expectations for service and technology and ease,” the design challenge advisory panel stated. “They explored having consumers pre-pay for services when very few if any others did.”

A patient focus group also noted that the medical billing solution was helpful because it allows individuals to connect to healthcare services from a smartphone.

HHS stated that the two winning designs will be implemented in six healthcare organizations and the federal department will test the solutions to determine if they improve the patient payment collections experience.

The competition addresses a financial issue that plagues both patients and providers. An InstaMed study from June stated that almost half of healthcare consumers would switch providers for the ability to better understand patient financial responsibility and pay using a preferred method.

Researchers found that consumers experience medical billing confusion because bills were mailed weeks or months after the healthcare encounter and the bills did not clearly explain how much is due and how to pay it. Consumers in the study also were also confused by separate explanation of benefits letters from payers that were similar to medical bills.

Implementing more electronic patient payment options may help providers to clarify medical bills and get patients to pay more of their financial responsibility, the study contended. About 70 percent of consumers preferred an electronic payment method and 64 percent expressed an interest in using a mobile payment system.

“With the dramatic shift in cost sharing and ultimately healthcare payment responsibility, a new, critical stakeholder has emerged, the consumer,” stated the study. “With the focus shifted to the consumer, both payers and providers will be challenged to overhaul their payment processes or face lost revenue and poor customer retention.”

Dig Deeper:

Key Ways to Boost Collection of Patient Financial Responsibility

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