Patient Friendly Billing Project: Putting the patient first - health care industry project plans simplification of patient billing processes

Healthcare Financial Management, Dec, 2001

Freeing the consumer from the confusion of the current billing and payment process is a key long-term goal of the Patient Friendly Billing Project. This project is a joint effort of HFMA and the American Hospital Association, and with support from HCA; Mayo Clinic, Rochester, Minnesota; Northwestern Memorial Hospital, Chicago, Illinois; Quorum Health Resources, Nashville, Tennessee; SSM HealthCare, St. Louis, Missouri; Cap Gemini Ernst & Young; Deloitte & Touche/Deloitte Consulting/ Ernst & Young; Pricewaterhouse Coopers; Stevens & Lee, Reading, Pennsylvania; Greenwich Hospital, Green-wich, Connecticut; Medical Group Management Association; and HFMA's PFS Forum Advisory Council. If the goal of this project is achieved, the healthcare industry can gain from both improved consumer relations and cost-efficient outcomes that benefit all involved.

Patients and their families have identified the patient bill as a " ...symbol of the confusion, mystery and the perception of high costs and overcharging. "a Healthcare financial professionals confirm that the billing process is a source of significant confusion and frustration.

The healthcare-billing process is a multiparty, interdependent relationship that is not within the control of any one entity. It is made up of a hodge-podge of processes that are both standardized and nonstandardized, manual and automated. A single bill can be a simple one-item charge or voluminous, when a variety of providers and payers are involved. And it is often the patient who is left alone to understand, coordinate, and navigate through a maze of bills, claims, referrals, authorizations, regulations, and explanation of benefits.

The current patchwork of benefit plans, payment systems, and billing formats creates a system that is expensive to operate and results in financial communication that is confusing, complex, and, too often, incorrect. Because providers, government, payers, employers, and, to some extent, patients are partly responsible for the complexity of the billing system, fixing this system involves everyone.

Consumer Focus

The Patient Friendly Billing Project is focused on the needs of the patient and consumer first. The consumer's perspective relates four key messages to healthcare leaders:

* Consumer satisfaction increasingly is driving the longterm success of healthcare organizations.

* The healthcare organization's nonclinical interactions with patients and consumers have as much on their satisfaction as clinical interactions.

* The patient-billing process (including insurance interactions) is a major cause of dissatisfaction for both patients and consumers.

* A patient friendly billing process will increase satisfaction and thereby increase the long-term success of healthcare organizations.

What is desired is a bill, or more precisely a flow of financial and other information to patients and their families that is clear, correct, concise, and patient friendly:

Clear. The bill is easy to understand and is written in clear language. The general type of services provided to the patient is documented. Patient and payer responsibilities are clearly stated, necessary actions are described, and a source of additional help and information is provided.

Correct. Bill items reflect the episode of care. Information on how patients can get more information or ask questions about their bill are referenced and available from the hospital's patient representative or from various written and Internet sources.

Concise. The bill contains the appropriate amount of detail necessary for the message communicated. Information on how to request a more detailed bill is included.

Patient friendly. In addition to being easy to read and understand, the bill should be easily matched with the payer's explanation of benefits (EOB); the patient's, the hospital's, and the payer/employer/government's understanding of the insurance benefits; and the episode of care.

Beginnings of the Project

HFMA and the American Hospital Association (AHA) have set out to examine what hospitals and health systems can do now to address consumers' concerns related to the billing process, and provide a forum and framework from which the rest of the industry could work. To examine the issues, HFMA and AHA assembled a task force of hospital and health system experts in the areas of provider registration, billing, contracting, follow-up, and collections to identify steps that can be taken immediately to respond to issues raised by patients and their families. The task force also identified future actions that can be taken to remove barriers to, or that facilitate, the clear, correct, and concise flow of financial and other information to consumers.

To gain the patient's and family member's perspective, the task force commissioned six focus groups comprising certain demographic and other characteristics of hospital and health system patients, including recent patients, patient guardians, and individuals with varying types of insurance coverage. Two additional focus groups were made up of hospital and physician office employees. The focus groups were conducted in four locations throughout the United States. The task force also collected examples of "better practices" being used by leaders in hospitals today for creating a more patient friendly billing process. Based on the feedback from the focus groups and these accepted better practices, the task force identified major concerns with the billing process.