Billing and Collections

IRS rules for curbing collections abuse among nonprofit hospitals are not specific enough and should also include for-profit providers, according to a new report in the AMA Journal of Ethics that blasts healthcare providers over some of their billing practices.

Under the rules, if patients don't know in advance that a doctor is out of network or if they have no choice, they won't be responsible for the bill. Instead, it's up to the insurer and provider to reach a payment deal through an independent resolution process.

The Pioneer Institute, a Boston-based public policy research group, called the offices of 96 dentists, ophthalmologists, dermatologists and gastroenterologists across the state last month, asking for the price of five basic services.

The 450-bed North Kansas City Hospital said it has partnered with CarePayment to offer patients financing options to deal with ballooning out-of-pocket costs.

At the top end, the highest median amount paid for the procedure is $61,231 in the Sacramento, California metropolitan area. On the other hand, the Birmingham, Alabama region books the lowest cost paid at $15,494.

Under the New York law, patients are generally protected from owing more than their in-network copayment, coinsurance or deductible on bills they receive for out-of-network emergency services or on surprise bills.

Grades based on which states have legislation that dictates price transparency portals be set up.

Aside from collections, the Peer60 report found 25 percent of providers plan to outsource contract management.

Patient satisfaction has become much more tied to costs as consumers pay more out-of-pocket for their healthcare expenses.

Prepayment, patient engagement and clear estimates are a success for St. Luke's Health System.