Practice Management

No One Likes Surprises

How to help patients navigate unexpected medical bills—and avoid them in the first place

Woman looking at medical bill

Surprise medical bills are a hot political issue right now, at both the state and federal levels. But while the pols slog through the legislative debate, what can your practice do right now to help patients?

An Ounce of Prevention

“It’s really about trying to avoid the surprise medical bill in the first place,” says Katie Gilfillan, director of healthcare finance policy for physician and clinical practice at the Healthcare Financial Management Association (HFMA). Here are some things practices can do:

  • Educate patients. “Often, [patients] are not aware of the coverage they have,” says Gilfillan. Even with plan details in front of them, patients may not understand terms like co-insurance, deductible, and out-of-pocket maximum, or know how to use the information to calculate their financial responsibility. Consider adding a health care consumer guide (see Additional Resources) to your new patient registration paperwork or as part of procedure prep to help get patients up to speed.
  • Educate staff. The health insurance system is so complex, even people who work with it every day can have trouble. Be sure your office staff know what networks you participate in, and at what level. It is also important to know the network status of specialists and facilities you refer to. The HFMA Patient Financial Communications Best Practices recommend annual training for all staff members involved in financial discussions with patients and offers an online training program.
  • Provide detailed plans for procedures. Most surprise bills come from surgeries or other procedures that involve a variety of providers. When you refer a patient for a procedure, provide them with a list of all the groups that will be involved in their treatment. "Cover the scope of care so the patient can plan appropriately,” says Gilfillan. Develop relationships with providers and facilities you refer to frequently so you are up-to-date on their network status and financial policies. For treatment you’re providing, give a written estimate and have the patient sign it.

A Pound of Cure

Despite everyone’s best efforts, there will be times when a patient receives a surprise medical bill. What then?

  • Do some detective work. Why is this bill a surprise? Was there a coding error? A misunderstanding of coverage? Was a provider out of network? You may have to instruct the patient to request more information, like an itemized bill. Information-gathering will help you help the patient in front of you and may help you prevent similar problems for future patients.
  • Take corrective action. If you find that the error originated in your practice, own it and follow through. Correcting coding errors and the like can take time; establish a protocol to ensure that staff are communicating regularly with the insurance company and keeping the patient up-to-date. Track errors like this and use the data to improve your internal processes.
  • Keep calm and carry on. Your staff not only need to know the facts, but they also need to know how to handle angry and frustrated patients. They need to “be empathic and ask the right questions,” says Gilfillan. Train everyone on basic skills for de-escalating tense encounters and identify one or two ‘patient-whisperers’ with more advanced skills and deeper knowledge of billing issues for escalations.
  • Build a knowledge base. Your staff can’t do the legwork for every patient with a billing problem, but they can refer them to others who can. Most hospitals have financial counselors, and many state departments of insurance offer access to counselors and other resources. Find out what’s available in your area now so you’re prepared when faced with an upset patient.

Additional Resources





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