Legislation addresses the meaning of ‘price transparency’

Aug 25, 2015 | Health Insurance Billing

One of the biggest trends that's shaping the trajectory of billing and collections is price transparency, or the open and direct communication of cost to patients up front. Most experts agree that when patients are thoroughly prepared with accurate billing information in advance, they're able to make more informed decisions about their choice of provider, timing of care and payment structures. However, in the rush for more transparency, it's hard to determine exactly how that word is defined. 

What constitutes an "opaque" or obfuscated bill? The State of New York recently adopted a piece of "no surprises" legislation that aims to address that definition with clear boundaries. 

"A bill is considered a surprise if consumers receive services without their knowledge from an out-of-network doctor at an in-network hospital or ambulatory surgical center, among other things In addition, if consumers are referred to out-of-network providers but don't sign a written consent form saying they understand the services will be out of network and may result in higher out-of-pocket costs, it's considered a surprise bill," explains Kaiser Health News. 

Many would consider these steps basic fairness, although in some jurisdictions, transparency is becoming increasingly regulated. Hospitals, medical centers, clinics, private practices and other care facilities can get ahead of compliance by enacting price transparency initiatives that fit their current operating model. This proactive approach can reduce friction as new expectations for transparency are set in the future. 

As the standards and practices of accounts receivable evolve, care facilities need the bandwidth to bridge changes with thorough attention. One of the best ways to relieve administrators of their overwhelming caseloads is to outsource receivables management. Contact Professional Medical Services today to learn more about how our solutions can help your health care organization.