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Don't Forget Denials When Aiming for Patient Satisfaction

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In May 2016, the Department of Health and Human Services (HHS) announced “A Bill You Can Understand” Design and Innovation Challenge: Help Patients Understand Their Medical Bills and the Financial Aspect of Health. Simply put, design a simplified medical bill that is easy to interpret.

Currently, there is no standard in place for consumer medical billing documents. As the notice points out, patients in the United States often have difficulty understanding the complex medical billing process and may not be aware of or understand the reason for multiple bills from multiple sources for one episode of care.  

The Challenge has two objectives:

  • Objective 1: “Redesigning the Medical Bill”: Improving the medical bill itself. That is, making it more readable and easier for the consumer to understand.
  • Objective 2: “Redesigning the Medical Billing Process”: Improving the overall medical billing process. Submissions could address any step in the consumer journey from the medical encounter to afterward (for example, providing information at discharge on the medical billing process, developing a consolidated bill, creating a unified billing portal, etc.).

HHS is aiming to help patients understand what they owe and why, while removing the assumption that patients have a thorough understanding of healthcare. But is the patient statement the root of patient dissatisfaction? The government thinks so, but denials play a big part in this equation.

Denials requiring rebilling and reworking claims contribute to patient misunderstanding and discontent. Take a medical necessity denial as an example – how does that translate to the patient if a provider bills for a service that was not medically necessary?

“This is one of the biggest complaints our clients receive in the billing office,” says Lori Zindl, President of OS inc. “Patients are seeing bills for denied services that could have been resolved with the proper claim edits in place. The interaction with the billing office has a lasting impression with the patient, and is often a deciding factor in whether or not they will return.”

About 90% of denials are preventable, so put edits in place to correct the claim before it gets out the door. The claim is paid accurately and timely, and paired with the easy-to-navigate patient statement, the owed portion is more easily understood.