Healthcare News & Insights

Following AHA’s updated billing guidelines protects hospitals, patients

The American Hospital Association (AHA) recently updated its billing and collections guidelines in light of the Patient Protection and Affordable Care Act (ACA). Following them to the letter can help your facility avoid a mess like the University of Minnesota Medical Center has found itself in.

As we previously reported, the center is under fire from the Centers for Medicare & Medicaid Services (CMS) for its allegedly overzealous collections practices.

The AHA’s updated collections guidelines lay a framework for hospitals to both serve their patients better and survive in a touch economic climate.

Taking these steps now will keep your facility from attracting unwanted attention for its billing policies.

Be up front about billing procedures

Communicating with patients about their billing options is of utmost importance. Hospitals should provide patients with financial counseling for their hospital bills. At this time, patients should be encouraged to ask questions and get the full picture about the costs of their hospital treatment.

Billing policies should be clear and easy to understand. They should also be readily available for review by patients. Patients shouldn’t have to weed through pages of medical jargon – they should be able to grasp their financial responsibility right away.

Make patients aware that financial assistance is available

The ACA says that all hospitals should have a written financial assistance policy. The policy should spell out which patients are eligible for assistance and how it’s distributed, and the criteria must be applied consistently.

Hospitals should make a reasonable effort to publicize their financial assistance policies for patients who may have difficulty paying for their treatment. Facilities can post the info on their websites, provide it directly to patients or distribute it to various social service and community agencies.

All hospital staff should be educated about how financial assistance works. They should also be aware of the hospital’s general billing practices in case patients have any questions or concerns.

Keep treatment as affordable as possible

Without sacrificing the hospital’s bottom line, every effort should be made to keep medical costs reasonable for patients who qualify for financial assistance. Periodically, hospitals should review charges to make sure they correlate with the cost of the service provided.

A provision in the ACA states hospitals should have policies in place to limit charges for medically necessary care (including emergency treatment) for patients who qualify for financial assistance. Their costs should be no greater than what’s billed to patients with private insurance.

Have a fair collections policy

Regarding billing and collections, the AHA states that “hospitals should ensure that patient accounts are pursued fairly and consistently, reflecting the public’s high expectations of hospitals.”

As part of the ACA, all hospitals should have a written collections policy in place that clearly outlines the steps the hospital will take in the collections process. To avoid collections issues, hospitals must first make reasonable efforts to determine whether patients qualify for any financial assistance before placing their accounts in collections.

And, hospitals also need to have a tight rein on their collections’ agencies. Written policies should be in place for their collection activities, as well.

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