5 Great Quality Enhancement Measures to Improve Medical Billing

Greater price transparency and lowering out-of-pocket costs are the key objectives leading to patient-centered care.

An argument put forth by two physicians from John Hopkins University emphasizes that medical billing quality is a type of medical quality that needs to be tracked the same way healthcare organizations track medical complication rates and other quality indicators.

Physicians Simon C. Mathews, MD, and Martin A. Makary, MD, MPH in a recent Viewpoint article in JAMA proposed five quality measures to track and improve medical billing quality.

Are the cost of procedures routinely provided by healthcare organizations presented to patients clear and organized? This proposed metric would determine that, being the first of the five that is being suggested by the two physicians. 

Despite medical codes and terms reflected in the bills, it is difficult for patients to decipher them. Improving this aspect of billing is the first step towards patient-centered billing.

Making Price Readily Available to Patients

Other quality measures proposed by the physicians center around price transparency. This second metric will determine if prices were readily available to patients. Except for a few US medical centers that provide patients the prices for medical services, most others do not provide it, which results in poor care quality.

Another important metric proposed by the two physicians focuses on the patient’s right to speak with an appropriate individual about any billing concerns. 

This option given to the patients will eliminate or minimise errors, and potentially  can be corrected to provide accomodation to patients, before an issue is reported. It will also make patients feel at ease, and not neglected when any medical bills need to be discussed.  

Suing Patients Over Unpaid Bills a Violation

Is it ethical suing patients over unpaid medical bills or is it a violation against the core mission of hospitals? According to Mathews and Makary, hospitals should be a safe place for individuals with any illnesses or injuries, and care should be available to patients regardless of the situation. This fourth metric deals with the issue of whether health systems are suing patients.

Out-of-Pocket Paying Patients Charged More Than Other Patients

The final metric proposes to address two issues. Firstly, should patients that pay out of pocket be expected to pay more than others for the same care?  Secondly, this quality metric assesses if patients directly have to bear the cost for any complications arising out of a serious adverse event, such as wrong-side surgery or operations to remove a retained foreign body.

According to Mathews and Makary, these medical billing quality measures have to be observed by healthcare organizations to assure patients they are receiving the highest quality clinical care, and the best financial experience. The physicians elaborated that the financial experience will impact access to care.

The level of debt in 2019 indicates that medical bills accounted for 58 percent of all debt, this research has been cited from a 2019 Consumer Finance survey that involved five million people. The research points out that  64 percent of 1,000 patients stated that billing concerns made them delay or neglect medical care in the past year, according to a February 2019 report.

Often patients with private or no insurance receive bills with prices that are in excess of the recommended Medicare amount. No healthcare cost expectations are provided to patients by healthcare organizations to help them shoulder the burden of medical care. In a 2019 JAMA study, only 53 out of 101 hospitals provided the cost for standard coronary artery bypass graft surgery.

These quality measures to assess medical billing performance, according to the two physicians can help improve patient financial experience, and influence the bottom line.

Organizations Advised to Include Billing Measures for Quality Assessment

Organizations such as CMS, Leapfrog Group, US News, and other organizations have been advised by the physicians of John Hopkins to incorporate medical billing measures into their quality assessments. The goal of these organizations is to provide transparency and the utmost quality of care to patients.

Concluding, Mathews and Makary propose that recognising billing quality as valuable information will lead to a more holistic  and patient-centered set of outcomes that can be measured for benchmarking and performance improvement.