Healthcare Billing Transparency

“If patients don’t know the cost of care and cannot see costs across providers they can’t seek the lowest cost as they can in any other industry,” Verma said in a phone call with reporters. “The lack of price transparency has resulted in a system that doesn’t allow patients to make value-based decisions based on out-of-pocket costs.”

The aforementioned is an excerpt from MedCity coverage on the new rule from CMS requiring healthcare service providers to post the standard prices online publically, which hospitals across the United States are expected to act on immediately.

You can read more what CMS Administer, Seema Verma has to say about this rule and what furthers need to be done to enhance patient’s high-value care.

Healthcare billing transparency is not a new discussion; it has been a heated topic for quite a while now. While some favor the new rule saying it will enhance and efficiently promote the healthcare consumerism, the critics say this move might further augment the ambiguity that is there within the consumers regarding the intricate healthcare system.

But what exactly transparency means?

It means the communication in the organization, within departments, the employees and customers should be open and truthful, so that consumers can make a well-informed decision that is not biased for the respective organization’s ulterior motives. Transparency in healthcare shifts the financial risk to the consumers, making them more vigilant before deciding on the medicines hospitals, doctors and other healthcare services. This will also burst the long-standing myth in healthcare that cost always equates to qualitative treatment.

How will it benefit the healthcare organization and consumers?

Healthcare transparency will have the impact of varying magnitude on different segments. While the value-based care decision’s prime focus was on dispensing quality treatment to the patients, with the new bill integrating cost and quality aspects will help in strengthening the healthcare finance systems.

PATIENT:

The right to access information will give patients a valuable insight into the cost and quality of the healthcare service which they are being provided. This will help them take a more informed decision. Patients will feel valued and would be appreciative of the healthcare service provider’s efforts in keeping them abreast with the latest updates on cost and quality. Take, for instance, some hospitals have started implementing the cost estimate procedure, which will be pivotal in answering a common contention of patients of how much do they spend out of pocket for the services i.e. the actual expense.

HEALTHCARE ORGANIZATION:

The staff in the healthcare organization would contribute towards creating a core quality centric environment. The transparency will boost internal communication and help staff be aware of where the healthcare organization is headed to with enhanced productivity. With the right use of tools and technology, healthcare billing transparency can improve operational efficiency.

What the critics have to say about the newly implemented healthcare transparency bill?

• Those apprehensive of labeling healthcare transparency a potentially successful tool in enhancing healthcare consumerism, think that it will add to the confusion that the consumers have about the information. They might have a tough time trying to interpret the information on health insurance and other finance related to the healthcare system.
• While the aforementioned cost estimate procedure sounds like a promising development in making healthcare service more patient and quality centric. The hassle of navigating through the procedure might irk the whole consumer experience with the inconsistencies in the information being provided.
• Also, while the law might have made it compulsory for the healthcare providers to publicize the rates of all the items and services, the tools required for adequate access to cost and quality information are limited. The consumer’s limited knowledge of these tools leads to low usage and engagement, which is one big obstacle for healthcare service providers to resolve.

Industry experts and healthcare service providers are divided on the implementation impact of the transparency rule but it’s in a nascent stage, so it would be too soon to theorize on it. What healthcare service providers do need to understand is keeping the consumers informed of the cost and quality of care would be beneficial in the long run as this will eliminate the useless healthcare cost-extensive utilization.

Healthcare billing and other financial aspects are intricate and critical for the sustenance of healthcare service providers and should only be taken care of, by a  professional medical billing and coding experts like Medphine. Medphine has a team of trained, certified and experienced billers and coders whose every strategy to manage the revenue cycle is compliant with the latest HIPAA policies.

The goal of Medphine’s experts is to minimize the claim denials, speed up the reimbursements rate, and mitigate your hassle of having to keep track of healthcare finances and concentrate better on dispensing quality treatment to the patients.

Medphine billers and coders will make sure that every aspect of your healthcare provider’s revenue cycle is adequately and accurately managed, aligned with the updated policies.

Get in touch with Medphine’s adroit billing and coding experts today!