“Why Are Medical Bills So Confusing?”

Shawn Gretz,
Ridiculously Nice Vice President of Sales

This is a question that the US Department of Health and Human Services (HHS) decided to tackle when they released a design contest titled “A Bill You Can Understand.” To view the report and winners visit: http://www.abillyoucanunderstand.com/. The report from the study does a great job of describing the problems patients have with the largest post-service touchpoint, the medical bill. The contest had two prizes: 1. Easiest Bill to Understand, and 2. Process -Transformational Approach to Medical Billing. This article is a synopsis of the problem areas the report found, along with solutions that the contest winners brought forth that we believe have true potential. We will also address what you can do right now to provide “a better patient experience.” (Besides hiring the Ridiculously Nice Early Out and Collection agency if you haven’t already!)

Problem-“Complexity Kills the Payment”

The first problem identified in the report was the complexity of charging for healthcare services. Issues raised in the report include:

1. Patients are confused by the fragmented care provided by multiple doctors and facilities who all bill independently;
2. Patients rarely know what they are going to have to pay before a procedure;
3. Patients do not know where to turn for answers to their billing questions; and
4. Patients do not understand the denial, appeal, and insurance resubmitting process.

Let me also include that studies show (including one done by www.policygenius.com) that on average patients do not understand deductibles, co-insurance, co-pays, and out-of-pocket maximums.

Problem-“Volume of Communications”

Consider from a patient perspective all the written and verbal communications that a patient receives from one visit. The complexity is mind-boggling to the point that it creates a barrier to payment. The communications include:

1. Pre-Service – Price comparison, registration, pre-authorization, and appointment reminder – Oh my! Each one of these touch-points have a potential for patient dis-satisfaction. The biggest medical service that has removed the complexity is the one we would prefer to steer patients away from, emergency care. There, a patient can skip this step and just come on in.
2. Appointment – At the appointment, the volume of communication continues. At the registration desk the annual HIPAA authorization, pre-service paperwork including authorization to bill along with Telephone Consumer Protection Act express consent. Then there is the verbal nurse’s instructions, verbal doctor’s instructions, pamphlets, prescriptions, and written instructions for after service.
3. Billing – Even after the service, the volume of communication continues.
   1. Explanation of Benefits (EOB) – First come the EOBs with their confusing language of deductible and co-insurance. Add in the coding for the procedures and doctor names that the patient doesn’t even recognize for service. Multiply this by the multiple EOBs for facility, ER, anesthesiology, radiology, or pathology bills.
   2. Statements – Next comes the patient statements that may be come 30-45 days later and not just from the facility but again from ED physicians, anesthesiology, radiology, and pathology. Each of these statements may or may not match the EOB. Let’s take the patient paperless. Great now you need multiple logins from each of the different services to pay for the service. Most emails that I have seen sent to patients do a poor job of describing the services because of HIPAA’s requirements to send a clear communication of who the patient was and what the services were for.
   3. Verbal – Next come the communications with a call center that hopefully is staffed correctly to handle the incoming volume.
   Each and every one of these communications leaves space for the patient to be dissatisfied or choose to seek services somewhere else. Combine with this that the article points out that patient understanding, terminology, timing, and trust plays a role in patient payments.Solutions Offered:
   1. Patient Journey Mapping – A solution can only be solved when you state the full problem. In this contest one of the requirements was to create a patient journey map of all the touch points from the patient revenue cycle, and qualify them as either producing a positive or negative experience; thereby stating the problem. I would suggest you try this process yourself. Bring together your team to follow a patient’s journey through the experience you are creating for the patient. Search for those positive and negative touch points and remove the negative when possible.
   2. Deductible and Out-of-Pocket Maximium – The organization RadNet revealed a statement design that included a pie chart with the deductible and out-of-pocket maximum information. Patients who receive a statement such as this may stop looking at the EOB, and wait for your statements to make it less confusing. This information would be available through most clearing houses at the time the statement is generated.
   3. Doctors – Another design change by RadNet was to show images of the doctors next to each itemized charge. This refreshes the memory of the patient making it easier for payment. Along with the images is a QR code that could quickly take the patient to a FAQ spot to describe the service or facility being charged for to explain away the complexity.
   4. All Physicians – A submission by St. Luke’s in Boise, ID brought together all physicians, regardless if they operate independently, onto the statement sent to the patient. Imagine if you could differentiate yourself by making it easier for the patient to pay by sending one statement for the entire service. Many groups and their billing companies struggle to find a way to continue to collect self-pay balances. By combining these charges with your self-pay charges, significant cost savings could occur from statements and phone calls for the physicians.
   5. Terminology – The simplest way to generate a statement is to use the already provided terminology on the charge master. This may also be adding unneeded complexity to the bill. Consider providing the statement company a different table to simplify the language of the charge master into what the patient can understand. Also consider viewing the EOB from time to time of patients to see if the insurance companies terminology matches your terminology.
   These five solutions can all create a better patient experience as does choosing the right partner to implement these. I suggest you look to implement these in the future or journey map your own solutions to the complexity.Americollect is looking for partners to build a “Patient Journey Mapping” case study with, including providing early out services for a hospital or health system and their contracted physician groups. The overarching goal being to improve your patient experience.  Let Americollect come on site with our team to map out the current patient experience and redefine the future with you. If you would like to explore this opportunity with us, reach out to Shawn at [email protected] or 920-420-3420.