Revenue Cycle Billing Challenges: Insights from Patient Experience

Revenue Cycle Billing Challenges

To enhance the financial experience of patients, it is crucial to closely examine an organization’s billing procedure.

HealthLeaders is joining the celebration of Patient Experience Week from April 23-29 by highlighting the efforts of revenue cycle leaders in establishing a favorable financial experience for patients in their organizations.

With a suboptimal financial experience capable of undermining a five-star clinical encounter, revenue cycle leaders are facing increased pressure to optimize processes for their patients. In light of this, where should organizations begin when aiming to enhance this aspect of patient experience?

As Vice President of Revenue Cycle at Atrium Health, pointed out to HealthLeaders, there are several hurdles present in the current market that can impede a patient’s billing experience. Focusing on identifying and resolving these challenges can play a vital role in fostering a favorable financial experience for patients. Bottom of Form

The amount of information presented on a patient’s bill can be overwhelming for certain groups of people.

Atrium Health’s Vice President stated, “Healthcare billing remains a convoluted process, particularly due to the involvement of the provider, patient, and payer. To be frank, when some patients come across the use of CPT and ICD-10-CM codes by insurers, it can seem like a foreign language and lead to actual confusion.”

An additional element observed throughout the healthcare sector is that patient invoices often continue to exhibit gross charges for the rendered service(s).

Atrium Health’s Vice President also mentioned, “Even though gross charges do not represent the precise amount paid by insurers or patients, we still rely on them for billing functions throughout the healthcare sector. Providers usually assume that patients are not bothered by gross charges, but that may not be true.”

“When a patient receives an itemized invoice and notices gross charges amounting to $100,000, they may suddenly become interested in those charges and not just their actual financial responsibility. Consequently, I believe that the medical billing process is still more complicated than necessary for our industry,” he added.

The healthcare sector has made significant progress in price transparency, but some groups may require additional guidance on comprehending the details of their final bill. Simplifying this overwhelming amount of information is a crucial move towards achieving a positive financial experience for patients.

Discussing the issue with patients and forewarning them about gross charges or deductibles can eliminate any unwelcome surprises on their bill. In addition to the excess coding and pricing data, it is not uncommon for patients to receive multiple invoices from different providers for a single treatment episode.

Atrium Health’s Vice President commented, “This can be perplexing for patients, and unfortunately, we have yet to find a solution for this issue.”

Furthermore, it is typical for a patient’s invoice to not entirely correspond with the explanation of benefits issued by their insurance provider. Getting multiple invoices for one visit and receiving conflicting facility and payer statements can significantly impact the patient’s financial experience.

Atrium Health’s Vice President added, “Although we are committed to improving and delivering more precise information to our patients, we still need to make significant progress in making this industry and its procedures more patient-focused.”

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