HFMA Has Announced Best Practices For Medical Bill Communication

HFMA recently announced new guidelines for conversing with patients in regard to the financial logistics of their case. HFMA president and CEO Joseph J. Fifer explained that these guidelines have become particularly necessary in a time when billing has become more complex as many bills contain information from multiple billers and payers. Further, the reality seems to be that patients are being held responsible for a larger and larger share of their bills.

Time and Place for Financial Discussions

The guidelines set forth by HFMA focused primarily on financial discussions that take place on the site of a particular institution where a patient is receiving care, such as in the emergency room, or in cases where financial details are discussed before service or at the time that a procedure is administered.

In situations where financial discussions occur on site, it seems particularly important that thought and consideration be given to where exactly discussions take place and who should be in attendance. Representatives from HFMA stressed that care should be given to ensuring that when finances are being discussed, patient privacy is respected at all times. This means that many institutions will need to have designated private areas for financial discussions, or other means of creating confidentiality for patients.

Patient Stability First

New standards dictate that when finances are discussed at the time of service, as may frequently be the case in emergency settings, medical billing discussions should only occur after a patient has undergone screening and has been generally stabilized. If emergency room doctors determine that a patient is suffering from an emergency ailment, billing discussions should only occur at time of discharge. In general, regardless of the severity of a patient’s condition, financial discussions should never occur in a manner that impedes on a doctor’s ability to treat the patient to the best of their ability.

Discussions Prior to Care

In situations where a patient does not require emergency care and financial discussions occur prior to a patient receiving care, effort should be made to inform patients of what kind of bills they can expect to incur prior to the time of them receiving services.

When at all possible, patients should be advised of the costs of treatment before expenses are actually incurred. During this time, patients should be advised of the degree to which their bills will be paid by insurance carriers and should have the opportunity to inform billing staff of their inability to pay certain bills.

Who Should Attend Billing Discussions?

The matter of who should attend billing discussions depends on the patient’s individual situation. In cases where a patient is adequately insured and demonstrates an ability to pay, dialogue about billing can generally occur between the patient or their representative and the institution’s financial representative.

In cases where a patient is uninsured or under-insured or otherwise demonstrates an inability to pay, financial discussions should also include a financial counselor who can help the patient navigate through their billing options.

What Topics Should Be Discussed With Patients?

In general, patient financial discussions should cover what procedures or services the patient can expect to undergo, and what costs will be associated with said services. During initial discussions, insurance coverage should be verified, and costs covered by insurance should be discussed with the patient or their representative. If a patient expresses anticipated difficulty covering their financial obligation, financial counseling should occur as both patient and healthcare provider should seek billing solutions.

In an emergency setting, patients should always be advised that their ability to pay will not have an impact on the care that they can expect to receive.