Uninsured Patients – Need for Ethical and Error-free Payment Collection Strategies

by | Last updated Jul 4, 2023 | Published on Dec 5, 2016 | Medical Billing

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Hospitals and physicians’ practices need accurate and ethical medical billing services to capture collections from those with and without insurance coverage. Medical billing errors and overcharging can lead to dire legal consequences for healthcare providers.

According to a Kaiser Family Foundation report, while the Affordable Care Act led to significant coverage gains, there were still 28.5 million uninsured nonelderly Americans at the end of 2015. Lawyers are advising people without coverage to be wary about unreasonably high emergency room medical billing practices. A recent article published in lawyersandsettlements.com points out that uninsured patients are in greater danger of overcharging by hospitals. Consumers are advised to scrutinize their medical bills for errors and overcharges, ask providers to take corrective action, and if all fails, seek legal help.

A study on the practice of overcharging for emergency care in the US, which was published in Health Affairs last year, revealed that:

  • Hospitals try to bill uninsured patients at a higher rate than that of insured patients
  • On average, hospitals charged patients or their insurers 3.4 times the baseline rate for services mandated by the government
  • Up to 50 hospitals had the highest markup rate – on average, 10 times what it cost to provide treatment or services for the year studied, in 2012
  • 75 percent of the hospitals with the highest rates of hospital overcharging were in the south
  • 40 percent of hospitals that resorted to overcharging were in Florida – one showed a 1,260 percent markup for treatment and services over and above its costs to provide those services and treatment

In this scenario, patients need to be alert to the possibility for billing errors as well as the chances of receiving inflated emergency room bills and hospital overcharging. As patient collections play an important role in their revenue streams, hospitals have to take concrete steps to avoid billing mistakes, maximize revenue by identifying and correcting issues before claim submission, reach out to patients with payment information, and adjust their collection strategy.

Healthcare providers need an ethical and error-free strategy to collect payments from both insured and uninsured patients. An increasing number of patients with coverage now have higher deductibles and increased copays, while many consumers are forced to forego coverage because they cannot afford to pay the high costs of insurance. As the financial pressures facing healthcare organizations rise, efficient healthcare receivables management has become indispensable.

The first interaction between the patient and the provider is the starting point of a good payment collection strategy. Healthcare providers should conduct patient eligibility verification before services are provided to check coverage and payment responsibility. Once patients are informed about their responsibility, the physician’s office can work with them to collect their portion of the bill before they leave.

Practices should have a clear and ethical patient payment policy, commit to it, and convey it in writing throughout all treatment episodes. Patient payment guidelines offer the opportunity to collect money owed and may need adjusting collection policies, write-off levels, and billing frequency. Providers need to be flexible and prepared to offer patients options such as convenient payment plans.

Partnering with an experienced medical billing company can improve payment collection workflow. In addition to a skilled workforce to manage medical billing and coding processes using the latest technology, a reliable company would provide claims-processing reports that allow their clients to monitor and evaluate their workflow to improve efficiency. With the right vendor, physicians’ practices and hospitals will find it easier to manage their self-pay patients as well the insured class.

  • Natalie Tornese
    Natalie Tornese
    CPC: Director of Revenue Cycle Management

    Natalie joined MOS’ Revenue Cycle Management Division in October 2011. She brings twenty five years of hands on management experience to the company.

  • Meghann Drella
    Meghann Drella
    CPC: Senior Solutions Manager: Practice and RCM

    Meghann joined MOS’ Revenue Cycle Management Division in February of 2013. She is CPC certified with the American Academy of Professional Coders (AAPC).

  • Amber Darst
    Amber Darst
    Solutions Manager: Practice and RCM

    Hired for her dental expertise, Amber brings a wealth of knowledge and understanding of the dental revenue cycle management (RCM) services to MOS.

  • Loralee Kapp
    Loralee Kapp
    Solutions Manager: Practice and RCM

    Loralee joined MOS’ Revenue Cycle Management Division in October 2021. She has over five years of experience in medical coding and Health Information Management practices.