Archive for medical billing

Upfront Payments for ER Services: Is This Medical Billing Trend Creative or Corrupt?

When I read this article by Phil Galewitzon Kaiser Health News (in collaboration with the Washington Post) I was amazed, but not for the reason you might think.  Check it out:

Hospitals Demand Payment Upfront From ER Patients With Routine Problems

The gist of the article is that nearly half of the emergency rooms in the nation are now forcing patients who come in with non-emergency complaints to pay a fee upfront or else they are turned away.  $150 and $350 are both noted in the article, so the charges probably range pretty far.

I was amazed by this primarily because I agree with it!  In one way, it seems to go against the grain of what an ER is “supposed to do,” or at least what hospital emergency rooms have always historically done.  But as a medical billing specialist, I can’t argue with the logic behind the policy.

The article notes some startling statistics from HCA (the nation’s largest chain of for-profit hospitals):

 “Last year, about 80,000 emergency-room patients at hospitals owned by HCA left without treatment after being told they would have to first pay $150 because they did not have a true emergency.”

In other words, the upfront fee served as a deterrent to patients who didn’t really require emergency care.  Considering the fact that ER visits by uninsured patients often end up not getting paid, and that many people have actually become experts at “working the system” to use the emergency room to obtain free health care, this can translate to millions of dollars in savings over the course of a year.

It makes great business sense!

Of course, some doctors and patient care advocates are concerned, as the article also notes:

Physicians worry that sick people will forgo treatment. There is no data on how many who leave the ER without treatment follow up with visits to doctors’ offices or clinics.”

While I understand their concerns, it seems to me that combining this policy with some other measures may work better for everyone.  After all, when hospitals incur bad debt because of things like unnecessary and unpaid ER visits, all of us end up paying for it through higher healthcare costs.

So, here are a few ideas that might work:

  • Hospitals could make available a 24-hour walk-in clinic for routine complaints so that anyone showing up at the emergency room without a true emergency can receive the proper care (at the proper price) right on the premesis.
  • Maybe the price some of these ER’s are charging is a little high.  Maybe $50 is more reasonable. It could still work to deter those scam artists who are only out to receive services for free, while staying within reach of most patients with legitimate concerns.
  • Or, maybe educating patients about what they should expect from the emergency room is sufficient.  The Midland Memorial Hospital in Midland, Texas, has set up a 24-hour hotline where patients can call and speak to a nurse to help determine if they should come into the emergency room or visit a local clinic.  This, in conjunction with a $150 fee for non-emergency complaints resulted in a 10% drop in ER visits and a huge drop in bad debt as well.

I know this subject is going to spark some lively discussion, so let me know what you think: Is charging an upfront fee at the emergency room creative or corrupt?  How would you fix the problem of bad debt at the ER? 

Solid Suggestions to Keep Doctors From Going Broke

A few weeks back, I wrote a blog post responding to a surprising trend in healthcare:

What Gives?  Hospitals Hiring Broke Doctors

My main takeaway in that article was the fact that, based on the state of the economy, upcoming changes in insurance reimbursements and rising costs, hospitals need to focus not on cost containment and improved billing and collections processes to stay in the game.

I came across an article recently by Anthony Cirillo of Fast Forward Consulting that makes some great points on the other side of the story, how the individual doctors and smaller practices can adjust their outlook and processes to keep from going broke.

Check out the full article here:

How to Keep Docs From Going Broke

One of Anthony’s main points is a real key across the board in healthcare:  “What was revealed as a more systemic cause was the doctors’ lack of business acumen.”

And that is so true.  Little if any time is spent on business skills during all the years that doctors are in school.  Yet, running a successful practice, especially in tough economic times, isn’t going to be based solely on being a good doctor who knows how to treat patients.

As Anthony’s article goes on to point out, there are plenty of adjustments a practice can make to start running more like a successful business, with forward-thinking investments and partnership agreements that will allow a successful doctor to earn a solid living and a reasonable retirement.

Hand-in-hand with that kind of change, a practice can also benefit from outsourcing more of the behind-the-scenes running of the business to business professionals who specialize in handling those aspects of the medical field.

In all cases, the end goal is the same: to keep quality doctors focused on providing excellent care while staying afloat in tough times.

What kinds of changes have you had to make to stay profitable this past year?  Any mistakes you wish you could go back and change?  Let us know in the comments.

The Other Side of Medical Billing: Customer Satisfaction


For any private practice, larger facility or hospital, the main goal is and always should be caring for the patient.  Unfortunately, in the back office, where billing and collections take place, there seems to more of an “us and them” attitude.

In the long run, this can be damaging to the practice.  Especially in a world connected so tightly together by social media, your patients’ satisfaction can be a PR nightmare if legitimate complaints start spreading around cyberspace.

I came across an interesting article written by Sunni Patterson of Medical Bill and Claim Resolution.  I’ve pulled out a few key points, but you can read the full article here:

Hospital Business Offices and Healthcare Consumers

This statistic was an eye-opener:

“The number of consumers who gave top scores (5 on a 1 to 5 Likert scale) to hospital billing processes was just 21%.”

That means 79% of patients were dissatisfied with hospital billing processes to some extent.  That’s a huge chunk of patients, and a ton of potentially negative publicity!

It was interesting, too, that more patients were dissatisfied with their entire experience after dealing with the billing than those polled immediately after finishing treatment.  So issues with the billing process can change the minds of otherwise satisfied patients!

Obviously, billing and collecting on receivables is the lifeblood of the practice.  And, it’s not possible to make every patient delighted to pay.  That being said, there are a few things every facility should be focusing on during the billing procedure to try to mitigate negative feedback:

  • Speed:  Make the billing process as efficient as possible so the patient gets the bill quickly, while they’re still in a positive frame of mind and feeling good.
  • Accuracy:  The bill needs to be correct.  Coding needs to be current, with accurate insurance coverage and no erroneous, inflated charges.  Nothing makes a patient angrier than being billed for a contractual allowance that should’ve been zeroed out!
  • Communication:  The patient should be able to understand the bill they’re receiving and why they’re responsible for it, and, they should be able to speak to someone if they have questions.

We’ve been shouting this from the rooftops for years now, but I think these statistics stress the point again.  You want to be certain that your entire billing and collections process is running at maximum efficiency and accuracy, while maintaining positive communication with your patients and keeping them satisfied!  If this seems like a tall order, or, you’re lacking in one of these areas, you may want to consider outsourcing it to experts.

Have you run into any surprising patient satisfaction results recently?  Any thoughts on the stats in Sunni’s article?  Let us know in the comments.