Seventy percent of patients are confused by their medical bills. For healthcare providers, confusing medical bills are problematic for many reasons: They erode patient trust, increase patient dissatisfaction, decrease patient loyalty, and impede timely payment.
For example, imagine receiving a medical bill for a service you received in your doctor’s office. The bill includes several line items, one of which is a hospital charge. Obviously, you would be confused. Why would you be charged this type of fee when you saw your doctor in their office? It must be a mistake, right?
Unfortunately, it’s not a mistake. What you—and many other patients—may not understand is this: When a hospital owns a medical practice (or an outpatient surgical clinic or outpatient diagnostic center), that hospital may charge a ‘facility fee’ in addition to your doctor’s professional fee. The facility fee is designed to cover staffing costs and equipment associated with a hospital’s being open and operational 24/7.
Sorting out the confusion with facility fees
Facility fees, which can range from a few dollars to thousands of dollars, is a contentious topic with some experts arguing that hospital outpatient facility fees add to consumers’ and employers’ healthcare costs both through higher out-of-pocket charges and rising insurance premiums.
Not surprisingly, President Biden announced last year that he was concerned about patients being charged facility fees for healthcare services provided in a doctor’s office. As part of his efforts to reduce surprise billing, Biden said health plans and providers must make information about these facility fees publicly available to consumers.
Some states have already acted. For example Connecticut, Indiana, and Maine prohibit facility fees for selected outpatient services typically performed in an office setting. In addition, some states have targeted more specific services, including telehealth services (Connecticut, Maryland, Ohio, and Washington), preventive services (New York), and Covid-19 related services (Maryland, Texas, and, during the public health emergency period, Massachusetts).
Still, provider consolidation is exposing more and more consumers to facility fees that may have a disproportionate impact on marginalized communities. All of this necessitates the need for greater transparency and patient education. The goal? Eliminate confusion, promote patient satisfaction, and increase payment speed and revenue.
Providing patient education about facility vs. professional fees
While patients are becoming more aware of the issue, medical practices and billing companies must have strategies in place to provide patient support when questions arise—and rest assured, they will.
Consider the following:
- Educate staff on facility versus professional fees. Staff should be able to explain why patients are charged a facility fee and what that fee covers. They must be able to respond with empathy and validate any frustration the patient conveys. Payment plans may be helpful in terms of helping patients pay for any balances owed.
- Focus on price transparency. At the point of scheduling, patients should be told whether the office, clinic, or center is hospital-owned, and if so, whether it charges a facility fee (and how much). This helps patients make informed decisions about where to receive cost-effective care, and it also helps medical practices comply with the No Surprises Act and any relevant state requirements that may be more stringent.
- Leverage a variety of patient support tools. In addition to phone and email support, medical practices and billing companies can leverage live chat smart responses to answer common questions about facility versus professional fees. Patients may still have questions, but at least this gives them a foundation for understanding that the facility fees are, in fact, legitimate and accurate.
- Use clear and concise patient statements. Patient-friendly billing statements delivered via email, text, or paper mail should clearly differentiate between facility versus professional fees, including what, if anything, the patient’s insurance covers and what amount the patient still owes. It may also be helpful to include definitions of facility versus professional charges on the bill, so patients understand the difference. The bill should also include various methods to contact your medical practice if it’s still unclear.
Conclusion
Medical bills may confuse patients for a variety of reasons, one of which is facility fees they may not have anticipated. Providing multiple avenues for patient education helps medical practices meet patients’ needs while simultaneously improving payment turnaround time. Learn how Inbox Health can help.
About the Author
Lisa A. Eramo, MA is a freelance healthcare writer who specializes in healthcare reimbursement, health information management, value-based care, and patient engagement. She contributes bylined articles to various healthcare trade publications and also assists clients with healthcare content marketing. You can reach her at lisa@lisaeramo.com or by visiting www.lisaeramo.com.