Patient Experience Week: Examining Revenue Cycle Billing Challenges

When it comes to improving the patient financial experience, it's imperative to put the microscope on an organization's billing process.

April 23-29 is patient experience week, and HealthLeaders is helping to celebrate by spotlighting the hard work revenue cycle leaders put into creating a positive patient financial experience at their organizations.

At a time when a poor financial experience can negate a five-star clinical experience, revenue cycle leaders are under more pressure than ever to streamline processes for their patients. So where should organizations start when looking to improve this patient experience?

"There are quite a few challenges in the market today when it comes to a patient's billing experience," Chris Johnson, vice president of revenue cycle at Atrium Health, previously told HealthLeaders. Narrowing down those challenges and working on perfecting them will ensure a positive patient financial experience.

When it comes to a patient's bill, it's common for certain populations to find the amount of information presented overwhelming.

"Healthcare billing continues to be a complex process especially since you have the provider, patient, and payer all involved," said Johnson. "Quite frankly, when some patients see an insurer's use of CPT and ICD-10-CM codes, it can be like a foreign language, and it can cause real confusion."

Another added component seen across the healthcare industry is that patient bills still tend to show gross charges for the service or services provided to a patient.

"While gross charges are not the actual amount paid by insurers or patients, we continue to use them for billing purposes across our industry. Providers often assume patients are not concerned about gross charges, but this may not be the case." Johnson said.

"When we send a patient an itemized bill and they see their gross charges for $100,000—all of the sudden they are interested in those gross charges, not just what their actual financial responsibility is. So again, I think billing continues to be more complex than it needs to be as an industry," he said.

Price transparency has come a long way in the industry, but certain populations may need more education on what they are seeing in that final bill and breaking down this overload of information is an important step in achieving a positive patient financial experience.

Bringing that conversation forward and setting the expectation that a patient may see a gross charge or mentioning to a patient that they haven't met a deductible will help remove that surprise element from the patient's bill.

On top of this surplus of coding and pricing information, it's not unusual for patients to receive multiple bills from different providers for one episode of care.

"That can be confusing for patients. And again, it's not a problem that we have successfully fixed at this point," said Johnson.

Also, it's common for a patient's statement to not completely align with the explanation of benefits that the patient receives from their insurance company. Receiving multiple bills for one encounter as well as receiving mismatched facility and payer statements can greatly affect the patient's financial experience.

"While we are continuing to improve and provide better information to our patients, we have a more ground to cover in making this industry and process truly patient-friendly," Johnson said.