Medical Billing Quality Lacking According to Leapfrog Measures

Most hospitals do not have high medical billing quality, including patient access to a qualified billing representative and timely itemized billing statements.

A recent study published in JAMA analyzed medical billing quality for over 2,200 hospitals based on the Leapfrog Group’s new measures added to the 2022 survey. The Leapfrog Group, a national employer consortium, conducts an annual survey of US hospitals to determine quality for benchmarking and accountability.

In the 2022 survey, the Leapfrog Group added billing quality measures, including legal actions taken by hospitals to collect medical debt, timeliness of sending patients an itemized billing statement, and patient access to a qualified billing representative. The study analyzed hospital performance on those three measures, excluding two measures intended for use by the Leapfrog Group but at least partially addressed in recent regulations.

The study found that only 38 percent of hospitals in the sample reported meeting all three billing quality standards, demonstrating a widespread lack of medical billing quality in the US.

About a third, or 754 hospitals, reported taking legal action against patients for late or insufficient patients. Nearly 45 percent, or 1,020 hospitals, said they did not routinely send patients itemized bills within 30 days.

Additionally, some hospitals (5.5 percent, or 125 hospitals) did not provide patients access to billing representatives who could investigate billing errors, offer price adjustments, and establish payment plans.

Study authors from the Leapfrog Group, Northwestern University, and Johns Hopkins said whether the new proposed billing quality measures and standards indicate “reasonable and fair billing practices” requires further investigation. This is despite a clear indication that hospitals are underperforming when it comes to medical billing quality.

However, “[s]tandardized measurement and reporting of hospital billing practices could increase accountability, reduce variation in billing practices, and reduce barriers in access to care in the US,” they wrote in the study.

The healthcare industry has been calling for better medical billing standards to address large gaps in quality and patient understanding. Recent regulations, such as the No Surprises Act, have worked to bridge certain gaps in quality and medical billing. But some experts say hospitals can do more to improve their billing processes for patients.

One of the study’s authors, Martin A. Makary, MD, MPH, of Johns Hopkins University School of Medicine, proposed alongside colleague Simon C. Mathews, MD, five medical billing quality measures. The measures proposed in 2020 included access to clear cost estimates, price transparency, and access to staff knowledgeable about billing.

Makary and Mathews also said suing patients over unpaid bills is a violation of a hospital’s core mission. A later article in JAMA Health Forum called aggressive actions to collect medical debt from patients who cannot afford their bills, like suing them, should be a “never event.”

Healthcare affordability is a problem for many US adults, prompting government and industry leaders to address the issues patients and hospitals face with patient financial responsibility.