4 Barriers Providers Face with Preventing Surprise Medical Bills

A new survey uncovered the top four barriers hospitals and health systems are confronted with in their efforts to prevent surprise medical bills.

In the survey commissioned by AKASA and performed by the Healthcare Financial Management Association’s (HFMA’s) Pulse Survey program, financial leaders at hospitals and health systems said a barrier to preventing surprise medical bills is an incapacity to estimate reimbursement for providers of out-of-network clinical services who participate in procedures. A common example is anesthesiology, the survey stated.

Other top barriers include limited resources and staffing for patient financial counseling; delayed, outdated, or erroneous information from payers on patient eligibility inquiries; and inaccurate or inadequate information collected from patients during the registration process

The survey noted all the challenges healthcare financial leaders faced were equally ranked as the most prominent barriers leaders need to address in their facilities to prevent surprise medical billing effectively.

According to a Kaiser Family Foundation study, one in three insured adults stated their family experienced a surprise medical bill. Additionally, one in six insured adults has experienced an unexpected related to an out-of-network service. 

The study stated that surprise medical bills are typically over $500, putting patients through financial hardship. 

"A patient's healthcare experience is shaped by the care they receive and the support they get from healthcare's administrative function," Amy Raymond, head of revenue cycle operations at AKASA, said in the survey. 

"From the time they schedule an appointment to the bill they receive after a visit or procedure, being proactive and transparent with patients on the financial aspects can go a long way in creating goodwill and demonstrating how providers have the patient's best interest at heart."

Effective January 1st, 2022, the No Surprise Act will protect patients from unexpected out-of-network billing by restricting high out-of-pocket costs associated with surprise medical bills.

The law will require payers and providers to dispute out-of-network rates when surprise billing occurs. 

"A patient-first policy requires taking a close look at revenue cycle operations as this function serves as the foundation for the patient's financial experience with providers," Raymond said.

The researchers acknowledge that the No Surprises Act is a first step to addressing issues in the medical billing process. Still, there are more concerns lawmakers should address, including the rise of high-deductible health plans that often leaves patients unsure about medical costs.