How 2020 Changed Medical Billing

Given the chaotic year our industry has seen, it’s no surprise that medical billing is another aspect of healthcare that won’t escape the pandemic unchanged. We’ve learned a lot about each other, our patients and our industry. If the pandemic taught us anything, it’s that the status quo of an inefficient, outdated healthcare system cannot continue.

One thing that is changing is medical billing. Medical billing will completely change because of the events of 2020. Here are 4 key lessons we learned this year.

Transparency is a must-have, not a nice-to-have

When the government stepped in to help "cover" the cost of COVID-19 testing and treatment, many people applauded. But they couldn’t have known what they were thankful for, as nobody knew for sure exactly which costs were covered. This allowed health providers to set their own pricing, and has subsequently led to price gouging.

We’re aware of the poor practices related to price gouging for tests because coronavirus relief bills mandated some transparency: negotiated rates between payers and their out-of-network providers for COVID-19 testing must be made publicly available. Because of this, we learned some providers charged anywhere from $20–$850 for a single diagnostic test. However, payers do not have to make in-network negotiated rates available, leaving us to wonder what kind of pricing is happening behind the curtains—and how it will get passed on to consumers.

Given the calls for transparency from our medical community by the government, it was ironic that they wouldn’t fully prioritize transparency, and serves as a wake-up call as we think about future healthcare legislation.

Patients must be educated on their healthcare costs

Transparency means many things to many people. It could range from having one easy-to-read explanation of benefits to make healthcare costs easier to understand, to having the capability to deep-dive into negotiated costs between payers and providers.

As an industry, we need to teach consumers to better understand what their healthcare treatment regimens entail. Routine treatments like prenatal care, knee replacement and diabetes management all have fairly standard associated services, but we don’t educate the consumer on what those services are. If consumers don’t understand their treatment—or at least the costs associated with it—then they won’t feel empowered to make choices about the quality and cost.

A consumer revolution is here

This was a strange year for medical billing. To keep people protected amid a global health pandemic—one in which many lost their jobs and thus their access to healthcare—many insurers waived costs to help patients access prevention, management and treatment. Telehealth usage has exploded amid social distancing requirements.

These waivers aren’t just a nice gesture for good publicity, but are an important tool in helping to stop the spread. However, the healthcare community needs to remember that our patients are also consumers. This means that as we settle into a post-COVID world, one in which insurers are no longer waiving costs, the cost burden will be shifted back onto the employer and patient/consumer. What’s new is that consumers won’t be willing to go back to the old model for healthcare: rising prices, frustrating bills and lack of transparency.

They also won’t be satisfied with the outdated way of managing their healthcare, from their experience booking an appointment through to finalizing payments. The user-friendly digital interfaces they’ve learned to use in the past year have become the standard in retail experiences; they’ll expect it in healthcare too. When selecting a provider, they’ll consider a variety of factors, including quality, cost, transparency and consumer experience.

Patients should feel empowered to make decisions

Shopping for a healthcare provider is unlike shopping for retail items. That’s because we pay for healthcare through a complicated financial model, one that many consumers don’t fully understand (perhaps by design). Still, consumers do associate value with their healthcare services and are willing to pay for that value. They’re also looking to weigh quality versus costs in order to choose the right provider for them and their families.

The government is beginning to recognize this need too: in addition to mandating some price transparency in coronavirus relief legislation, the Centers for Medicare & Medicaid Services (CMS) issued a final rule on healthcare price transparency in October 2020, requiring health plan providers to make cost information easily accessible to patients online.

We can empower patients by meeting them where they are. Not only do they need transparent and accurate information about pricing, but they also need the right channels to find a provider, understand their coverage and benefits, and make payments. Comprehensive technology and customer care solutions are now even more critical for providing a strong consumer experience as patients become even more discerning.

While the healthcare industry has arguably been hit hardest by the COVID-19 pandemic, it’s also been an impetus for change. Patients will no longer be satisfied with the status quo in healthcare, and a consumer revolution is happening in medical billing.

Written by associates of Health Payment Systems.