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A healthcare System without Surprise Medical Bills is a Progressive System

Health is an important asset to human beings. Patients, physicians, medical billing companies, insurance companies, clearinghouses, all are connected in one way or another to offer quality services. Physicians are then reimbursed for their services and that’s how the process flows.

Patients are particularly free from the burden of paying for healthcare expenses by themselves when they get a healthcare plan. They just have to pay their premiums, and the rest is the work of medical billing outsourcing companies.

In recent times, the payment system in the US healthcare system has especially been under scrutiny to facilitate patients and clinicians alike.

Healthcare Costs Have Gone Up

Due to inflation and in the name of empowering patients, costs have gone up severely. Deductibles and copayments have increased, and patients can’t do anything about it as they have to maintain their monthly healthcare package in check.

Increasing expenses for care services have left patients financially vulnerable. According to an estimate, patients paid around 35% of the medical bill charges in 2019. Looking into it, this percentage is quite high as compared to the previous years.

The reason behind this is that patients have to endure surprise medical bills, and medical billing services were not to blame for this. Stats show that two-thirds of American adults, have savings less than $1000, and it is not enough to pay surprise bills sent by medical billing companies. Believe it or not, surprise medical bills are one of the causes of making families bankrupt.

All Stakeholders of Healthcare Industry will Suffer If Not Done Something to Resolve Surprise Medical Bills

A poll conducted by Kaiser Health Tracking in 2018 reflected that sixty-seven % of the Americans are somewhat worried about bearing unexpected healthcare costs for themselves or family members.

Another study showed that forty percent of the Americans who had insurance received surprise bills in 2019.

Forty-one of the Americans showed their concerns about how unexpected it was for them to see the bill going overboard.

The problem is huge. If patients are unable to pay for the rendered services, how will physicians survive? Medical billing services will not be able to get clear bills for physicians. The inability to pay bills and deductibles has increased seventeen percent from 2012 to 2016.

The US government has also noticed this issue, and there are multiple solutions into consideration.

What is the Solution?

Negative payment cycles can be reversed if taken proper actions against it.

One way to restrict the ever-increasing cost factor in the healthcare industry is to offer customized/personalized experience for patients.

The healthcare and billing process can be confusing for patients. A professional medical billing company on behalf of physicians should demonstrate each payment clearly to patients beforehand. From the appointment session to the final bill, every step should be clear to exclude the surprise element from bills.

The first strep of accurate billing services is to precisely estimate the cost of healthcare.

Medical billing outsourcing companies should break down each step for physicians to give them an idea of what patients can bear from their health plan and whatnot.

Listing payment options is also useful for patients when comes to out-of-pocket expenses.

Providers who work in efforts to improve the quality of healthcare and reduce surprise billing can enjoy a significant improvement in revenue cycle management. One can’t expect a sudden change in the healthcare industry, but a seamless billing process without surprise bills is only possible via offering tailored payment models based on the patient’s financial situation.


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CMS Plans to Expand RSNAT All Across America

CMS (The Center for Medicare & Medicaid Services) works for quality care and optimized performance in the healthcare industry. The healthcare industry leaders are focusing on every aspect and taking measures step-by-step to simplify operations.

Apart from announcing advancements in medical billing services and other healthcare operations, they also consider aspects of non-emergent care.

Recently, CMS announced to expand Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) across all America.

According to CMS, before the expansion process, RSNAT Prior Authorization Model will test the need for prior authorization of services.

What will be the outcome if outsourcing medical billing services seek approval before the service is rendered or before they send the due claim to the payer? Will it save cash for Medicare while trying to achieve quality healthcare for repetitive, scheduled non-emergency ambulance transportation?

Let’s find out.

CMS implemented this model in several states of America

An Overview

Such as New Jersey, Pennsylvania, South Carolina, North Carolina, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia during different years to test out its implications.

The results were quite astonishing and encouraging to say the least. The quality of care and easy access to essential services were maintained as expected. Statistics show that Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport saved around $650 million over four years.

The Need to Implement a New Model

Medical billing services used to face problems related to improper/inconsistent Medicare payments for non-emergent ambulance transports. There was a much-needed room for a new payment model that promotes cost efficiency and counters risks related to payments.

And, CMS wants to ensure proactive measures that minimize fraudulent activities.

Is the New Model Successful?

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The first evaluation report of this program came under analysis in 2018 and based on that, CMS is hopeful to expand it nationwide to curb down Medicare Spending. The recently released second evaluation report also highlighted that the use of RSNAT is reduced by 63% and its respective spending is reduced by 72% overall. (The report results were concerning the end-stage renal disease and/or severe pressure ulcers during the first four years of the model.) However, it supported the previous assumption that it is safe to implement this program everywhere. There was also no evidence against this system that reflected poor healthcare quality.

CMS has made clear that across the board accountability, lesser loopholes for frauds, simplified solutions, and expanses in check will make a progressive healthcare system. Moreover, with the new plan, medical billing services, physicians, and patients, all will be benefitted in one way or another.

CMS administrator, Seema Verma says that although medical billing experts complain about the complexity of prior authorization. But, with a proper plan of action and accurate deployment of the model, Medicare can ensure that its requirements are met even before the start of the service.

One more advantage of this system is that billing experts on behalf of physicians don’t have to indulge in extra administrative work afterward.

Henceforth, the program will continue to run in the currents states although they were expected to end this year. But, the success of the new model of non-emergency ambulance transportation changed the whole view.

CMS will release new guidelines regarding the expansion in every state. The model will remain the same as the existing model.

It is expected that medical billing outsourcing companies will find this new model accommodating with respect to maintaining cost.

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HHS Says: No Surprise Bills for COVID Patients

HHS – The U.S. Department of Health and Human Services (HHS) reserved excessive budget as emergency funds for COVID-19 response efforts. Now, the healthcare professionals affected by the pandemic in any sort (lack of services, resources availability, etc.) can apply for assistance and compensate for their loss.

However, once they apply for these COVID-19 relief funds, the government bars them from sending out-of-pocket care expenses to corona patients. In simpler terms, as claimed by the HHS officials, this program exempts patients from surprise medical bills and supports the financial concerns of all stakeholders (physicians and patients).

Medical billing services of this day and age, in alignment with the program, have to work accordingly. Since they represent practices and their awareness matters, the peace of physicians and patients have to be their top priority.

Just a Reminder, What Are Surprise Medical Bills?

Surprise medical bills are where a patient has to pay the difference between what the insurance pays for them and what the actual charges are for services taken. For instance, if you went to see your doctor, and the care costs reach up to $100 while your insurance only covers $70, the difference, $30, is what you have to pay out of your pocket.

COVID-19 Funds – Terms of Use

In terms and conditions of the emergency relief fund of COVID-19, HHS established that they consider every patient a COVID affectee, whether it is a probable or an actual case. Hospitals and medical billing services have to sign a deal that would not charge out-of-pocket expenses from patients if their insurance plan does not include those services (a practice referred to as surprise billing).

The debate continues if the HHS has banned surprise bills, which was a primary cause of distress for patients and physicians. Because medical billing outsourcing companies often find it hard to collect additional charges from patients.

HHS states that they are trying to clarify terms, which will ultimately help in comprehending the implications of getting the COVID aid. For now, the surprise billing banning extends to only COVID-positive cases.

Healthcare leaders are also in confusion about the legal complications and challenges of the payment balancing. There is still a lot of clarity required to satisfy all queries.

Surprise Bills during Pandemic – The Role of Medical Billing Services

Apart from the HHS efforts, many states are coming forward with policies that prevent patients from surprise billing. It means it is time to consider patients with out-of-network healthcare plans as in-network patients.

It is a critical step toward balancing the shaky healthcare economy and stop the high consumption of resources. Besides, the instability in the healthcare ecosystem is making it nearly impossible to meet ends from patient and physician perspectives.

Medical billing services assist practices with payments in this regard. They also furnish weekly or monthly reports, as suited, to relieve physicians of any revenue stresses.

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Physicians for fair coverage, the non-profit, have proposed a ban on surprise medical bills already. The government’s appropriate measures against surprise billing for COVID patients are incredible and in line with the aspirations of COVID affectees. We must continue this collective effort against balance billing, the goal of which is to attain peace of mind for our doctors and patients.

Via reducing or eliminating surprise bills, provided with a balanced financial solution for medical practices and medical billing services, can make up for lost revenues and maximize revenue opportunities.

What are your thoughts on this?