Did your patients ever face surprise bills? How did they overcome the situation in RCM medical billing? Have you ever tried to put an end to it? Some researchers warn that new state laws are designed to protect patients from being hit with steep out-of-network medical bills that may contribute to higher health care costs and premiums. This article brings you a different angle on surprise bills and how to avoid them in RCM medical billing.
What are Surprise Bills in RCM Medical Billing?
- When it comes to surprise bills, they are charges billed when an insured person gets treatment from an out-of-network provider due to emergencies.
- Surprise bills have become very common when a patient visits an emergency room or in-patient facility. The reason is when in an emergency; you miss entirely to cross-check if the provider is in-network.
- Similarly, in the case of in-patient services, there are chances that the patient’s attending physician is not in contract with your insurance through the hospital or the practice is under your insurers’ network.
When do patients receive Surprise Bills in RCM medical billing?
- When the patient is on vacation and has no access to an in-network provider and gets treated by an out-of-network provider.
- They can select an in-network hospital or practice; however, they later find out that your physician is not in-network with your insurer.
- Healthcare services received from an out-of-network provider, emergency room, ambulatory services, or ambulance provider lead to surprise bills as your payer does not accept them.
- The healthcare provider you know for years is no longer in-network with your insurance and misses to inform you about the changes.
- A patient’s Primary Care Physician (PCP) refers you to an out-of-network specialist, and you forget to check if the specialist is in-network for your insurance to cover your bills.
Unexpected & Unaffordable:
- Surprise billing expenses have become one that most people think about mainly because of two primary reasons. They are:
- The first reason is because of the higher amount the healthcare practice or physicians bill them. An in-network provider is in contract with the patient’s insurance company for negotiated charges and bills accordingly. However, the out-of-network provider is not in a contractual agreement with the insurance company; hence, the billed amount is comparatively much higher than the patient can afford.
- The secondary reason is that surprise bills usually come as an unexpected and additional cost or expense to their existing insurance plans. These surprise bills are mostly unaffordable for the commoner.
How to Avoid Surprise Bills In RCM Medical Billing?
A Keen check Before Availing Any Planned Healthcare Services:
- Before obtaining any planned medical services, you will have to ensure that the hospital and all the providers attending or providing the treatment are in-network and current with your insurance company.
- Also, keep in mind to cross-check every time you avail of the healthcare services as there are many chances that the hospital or physician in the network is not accepting your insurance anymore.
- Even before getting any emergency services, if possible, you can inform the attending healthcare professional about your insurance policies and your preference to be treated by an in-network provider to avoid unwanted bills in RCM medical billing.
- While making an appointment, it’s crucial to make it a practice to check the healthcare provider and network details to avoid last-minute hassle and confusion.
Most important things to note if you receive a Surprise Bill:
- If at all you have received services from an out-of-network healthcare provider and have received a surprise bill, please follow the below:
- Contact your service provider and try to negotiate on the billed amount.
- Check on the available payment plans
- Contact your insurance company, explain your emergency, and see if they can help or negotiate with your physician.
- Appeal with the state insurance department as they can negotiate on behalf of you with your provider or with your insurance company.
Latest updates on Laws released for surprise bills:
- The State law Federal Legislation has constantly been protecting patients or consumers against surprise bills by enacting effective laws to control such instances.
- But not every state had effective methods and rules to limit private physicians and hospitals or healthcare organizations from surprise billing and balance billing.
- When it comes to the protection of patients against surprise bills, each State varies in terms of its limitation and regulation and has its limitations.
- A new law was released by both the Federal and State government according to which:
- Patients would be responsible for cost-sharing only for in-network coverage bills in an emergency and certain non-emergency cases, where the patient does not choose to select an In-network provider.
- Out-of-Network providers are prohibited from billing their patients for the balance unless they were informed 72 hours in advance about their coverage status with the estimated charges and received the patient’s consent to receive out-of-network services.
- If the patient was not informed 72 hours in advance, the bill needs to be resolved by the insurers and providers or by an independent dispute resolution process.
- Stacey Pogue, a senior policy analyst at Every Texan, a social justice organization that pushed for a surprise billing law in Texas, said such measures “did the most necessary thing of protecting consumers.”
- Pogue also acknowledged that there might be unintended consequences. “We were also concerned about inflationary costs, and the jury is out on that,” she said.
- “An upward trend in payments for out-of-network care could push rates higher in in-network contracts,” health policy researchers at Georgetown University wrote in a blog.
- State legislators in several states said reaching a compromise on the bills was a long and unusually contentious process. “I was told it was never going to get done,” said Texas Republican state Sen.
- “Providers like to pretend charges reflect something, but they are just charges,” said Paige Duhamel, health care policy manager in New Mexico’s Office of Superintendent of Insurance.
- States that enacted surprise billing laws rejected insurers’ and doctors’ arguments and instead adopted different standards.
Surprise Bills in RCM medical billing are not new for patients. Most of them, without their knowledge, face out-of-network providers and get these bills connected with huge expenses. To avoid them, learn or research about the provider more than what you needed in the service.
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