Healthcare Payment Compliance and Transparency in Medical Pricing

Anyone working in the healthcare industry knows the human body is complex. The human mind is equally complicated. It can struggle to comprehend difficult matters, especially when it comes to money. When it comes to healthcare pricing, this is becoming increasingly important to bear in mind. There is a drive today toward greater pricing transparency. Patients need to be aware of what they’re expected to pay for their treatments.

As out-of-pocket expenses go up, the need for transparency grows. However, there will always be variables when it comes to treatment pricing. It’s hard to anticipate complications or unexpected lab results. This makes transparency even harder to achieve. Despite this, when patients are paying more for their care themselves, they need a better understanding of the process. They also need to be confident their money and details are safe. Therefore, pricing transparency and healthcare payment compliance go hand in hand.

Achieving Pricing Transparency

Although your practice could simply put a price on all the ICD-10-CM and ICD-10-PCS codes, this is unlikely to work. After all, doctors can spend considerably longer diagnosing one patient than another.

So, imagine you assign a set price to one specific treatment. You tell the patient this figure is his or her “primary price.” Although you tell your patient that figure won’t cover complications that may arise, he or she won’t pay attention to that. Your patient will end up arguing with the practice about the amount he or she will need to pay. If you discover further issues while the patient is undergoing a procedure, it becomes even more complex. You’ll need to quote the patient further prices for extra procedures. The situation becomes untenable.

With the market pushing forward with pricing transparency, it’s important to try to overcome these difficulties. So, here is some expert advice to help your practice get off to the right start.

Cost Studying Common Codes

Begin by taking around 10 to 20 of the most commonly used codes at your practice. Carry out a comprehensive cost study for each procedure. Count the amount it costs your practice for every element of that code. Don’t forget man-hours, data input, paperwork, physician time, collections and billing, and even postage. The cost of just one simple diagnosis may surprise you!

Pricing the Codes

Once you have fully tracked down those costs, you must put their margin onto the figure. Do not forget to cover overheads, such as rental, equipment, insurance, and supplies. Compare this figure to the prices quoted by practices near yours. Can patients receive identical care at another local practice at a lower price? If so, you need to find a way to cut your costs. Otherwise, patients will simply get their treatments elsewhere.

Providing Estimates

The key to successful pricing transparency lies in only providing estimates rather than hard prices. Give patients a range of figures for their procedure. If, for example, the treatments they need could cost anywhere from $80 to $130, tell the patient this. Explain to the patient why there is a range of prices. Make sure that you also put in writing that this price is only an estimate and not a set price. Then, you can refer the patient back to this if he or she argues about costs later.

Maintaining Compliance

Part of pricing transparency must also include reassuring patients about the safety of their payments. This is especially the case for practices that have adopted the latest online payment portals. While these offer an excellent way to keep cash flowing through the practice, they can raise concerns. Some patients worry that their financial information or personal details will be at risk. They are used to paying in cash or with paper checks, so change can be worrying. They are scared of cybercrime, so this may deter them from entering card details online. Healthcare payment compliance is, therefore, essential to reassure patients.

HIPAA compliance is now a requirement across the medical sector. Practices of all kinds and sizes must comply with these regulations. Physicians must reassure patients that their practices or hospitals are complying. This is why it is so important to choose the right payment processing solutions. When practices select a reputable payment processing services provider, they can be confident their compliance requirements are being met. They can, therefore, confidently reassure their patients that their payments and details will be properly protected.

BillingTree offers healthcare billing and payment solutions that are fully HIPAA compliant. All of our procedures, controls, and processes are fully certified. This means that when practices adopt BillingTree’s systems, they can have the peace of mind of knowing they’re fully compliant.

Transparency must include all elements of patient payment for their care in today’s medical environment. Healthcare payment compliance is a key element of pricing transparency and BillingTree can help practices achieve this.