Patients Are Fed-up

Surprise medical billing has become a nuisance that extends beyond the traditional concept of being an "out of network" issue.

Patients are reporting getting unexpected medical bills for services at in-network/participating entities too. And their cry for help is no longer falling on deaf ears.

What is Surprise Medical Billing?

Surprise medical billing is balance billing patients for services not paid by insurance carriers. If a provider feels that adequate payment was not achieved for services rendered, the common practice has been to bill the patient for the outstanding balance.

Patients are unaware that medical bills are mounting because they have made due diligence to seek services at an in-network facility. The catch is that they unknowingly receive treatment by healthcare professionals who are out of network. This includes patients who are serviced by providers who haven't been given prior authorization from by the insurance carrier to treat them.

Federal Regulations Now Underway

It's safe to say that some of the federal laws will be changing and your billing practices will be affected. Several initiatives are now being made at the federal level to push legislation to end surprise medical billing. The goal: protecting patient rights.


Combat Surprise Medical Billing

Surprise medical billing has been a common practice for some professional healthcare practices for years. Although the new congressional efforts are being addressed primarily for facility balance billing, there is a direct correlation of how this will affect balance billing across all spectrums of healthcare, which will include private practices.

There are several things you can do to ensure that your practice is never the causing factor of this issue for your patients. Below are a few suggestions that I recommend:

1. Educate Your Staff. The internal collection practices of your office should be held as the standard of how to execute business. Give them the resources they need to execute your collection process efficiently, within compliance, and implement proper protocol when servicing your patients.

2. Secure SIGNED ABNs from your patients when suggesting services that may not be payable by Medicare and other insurers.

3. Be thorough in your consultations with your patients. Your reputation is at stake. Your job as a provider is to safeguard the rights of your patients. Guarantee that patients have a sound understanding of what services could increase their out-of-pocket costs even AFTER they have signed an ABN.

4. Deploy timely invoicing. This is the most crucial aspect. There's nothing worse than receiving a bill 2 to 3 years after the initial visit. Now, understandably there are different factors that can cause a delay in billing. However, always do your best to strive for fair billing practices.

5. Align your practice with an experienced medical billing company that is extensively abreast of the current affairs of healthcare regulation that directly affect your revenue cycle management. This is extremely important because adhering to billing compliance policies is unavoidable and you lessen the risk of incurring penalties and losing contracts and facility affiliations for your practice later down the line.

Critical Thinking | Applying Action

  1. Have you identified any causes that perpetuate this issue in your practice?
  2. What other changes can be implemented among your staff to help alleviate surprise billing for your practice?

Since 2001, Simone Harris has developed a solid foundation in administrative healthcare services and business development. She has 20+ years within the healthcare sector and serves as the Executive of Business of Operations and Compliance Officer. Modified Solutions is furnished with professional medical administrative resources that are firmly rooted in compliance, integrity, and experience. To learn more visit