New billing standards could help some patients with debt

New medical billing standards, coming from government and the hospital and bill collection industries, should make resolving disputes and paying bills easier and fairer for patients, experts say.
Published: February 15, 2014
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The last thing anyone wants to deal with after a serious illness or injury is a mountain of debt and repeated calls from bill collectors. Yet that’s the scenario in which many patients find themselves.

Patients can avoid some of those headaches and minimize the risk they’ll need to file for bankruptcy protection. To do that, they must discuss costs and payment options early on with their hospital or medical provider, and be sure that they have tapped into any available discounts and financial assistance.

But new standards, coming from government and the hospital and bill collection industries, should make resolving disputes and paying bills easier and fairer for patients, experts say. That’s really needed as consumers face growing medical bills.

Health care spending jumped from an average $2,854 per person in 1990 to $8,915 per person in 2012, according to the Centers for Medicare and Medicaid Services; although the rate of increase slowed beginning in 2008 due to the Great Recession. Now employers are aggressively shifting health costs onto employees, through higher co-payments and monthly premiums, bigger deductibles and reduced co-insurance, which sticks patients with a bigger chunk of major medical bills — sometimes tens of thousands of dollars. For uninsured patients, it’s even worse.

The number of working-age Americans who said they were having trouble paying medical bills or were paying them off over time hit 75 million, or 41 percent, in 2012, according to surveys by The Commonwealth Fund, a foundation working to make health care better and more accessible. Meanwhile, medical debt is a top cause of personal bankruptcies.

“People are generally shocked when they find out what things cost. Try to negotiate (with the care provider). Talk to them up front,” says Mark Rukavina, founder of Boston-based Community Health Advisors. It works with hospitals around the country to develop financial assistance, billing and collection policies that meet new regulations.

New industry guidelines for resolving disputes about medical debt, announced on Jan. 15, should help patients struggling financially. Although voluntary, they’re expected to be widely adopted because they were developed by groups including ACA International, an association of collection agencies, and the Healthcare Financial Management Association, which represents financial officers at health care providers and insurance companies.

Joe Fifer, HFMA’s president and CEO, calls the guidelines “mostly common sense.” Among other standards, they recommend making bills easy to understand, ensuring hospitals and collection agencies aren’t sending a patient bills at the same time, and notifying credit agencies when a billing dispute is resolved so it’s removed from the person’s credit history.

Meanwhile, the Internal Revenue Service is expected to soon issue regulations, required by the Affordable Care Act, barring nonprofit hospitals — about half those in the U.S. — from charging uninsured patients more than the discounted rates for insured patients.

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People are generally shocked when they find out what things cost. Try to negotiate (with the care provider). Talk to them up front.”

Mark Rukavina,
Founder of Boston-based Community Health Advisors

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