Federal law requires that all nonprofit hospitals have financial assistance policies to reduce or expunge people's medical bills.
New research from Dollar For, an organization dedicated to helping people get access to charity care, suggests that fewer than one-third of people who qualify for charity care actually receive it.
What are the tangible ways AI can make this process easier? The most obvious improvement is in the claims scrubbing process, something historically managed by clearinghouses—a tool that allows providers to easily send batches of electronic claims to different insurance payers at once. Clearinghouses reject malformed claims before they get sent to payers based on certain universal rules, which include formatting issues, incorrect use/combinations of codes or conflicting insurance information. Using payer policies as ground truth and learning from every denial, AI tools can create a comprehensive rule engine for each individual payer so that no claim is denied for the same reason as another, taking the onus off the biller to read and remember policies, which are often unnecessarily complex and constantly changing. Then, with access to the EMR, AI could automatically resubmit a corrected claim, or flag the issue if information is missing. Eventually, a billing team would no longer be necessary—the rules engine would allow the AI to build the claim correctly on its own.
A debt collection trade group filed a complaint in federal court challenging a CFPB advisory opinion that warned debt collectors against seeking payment on unverified or potentially inflated medical bills. The trade group's complaint alleges that — among other things — the CFPB's medical debt collection guidance exceeds the agency's authority, imposes unlawful new compliance rules, is politically motivated, and imposes costly burdens.
Acadia Healthcare Co. has agreed to pay $19.85 million to settle allegations the company billed for medically unnecessary inpatient behavior health services, DOJ says. Acadia will pay $16.66 million to the federal government for false billing under federal health programs, and will pay $3.19 million to Florida, Georgia, Michigan and Nevada to resolve their state law claims.
America’s hospital system is severely fractured and facing a crisis, but all the finger-pointing has been in the wrong direction. Over the past several months, the U.S. hospital system has emerged as a battleground of crisis narratives, where finger-pointing at real estate investment trusts (REITs) has overshadowed the true crisis at hand.
