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Billing Quality is Inextricable From Medical Quality

Analysis  |  By Alexandra Wilson Pecci  
   February 04, 2020

Calling it "a type of medical quality," two physicians have proposed five quality measures for determining medical billing quality.

Improving the patient financial experience is a top priority for most revenue cycle leaders, and redesigning patient bills is often a key part of that work.

But what, exactly, are the elements of a patient-friendly, useful medical bill?

That's the question that two physicians at Johns Hopkins Medicine are trying to answer in an article in the Feb. 4 issue of JAMA.

Simon Mathews, M.D., and Martin Makary, M.D., M.P.H., have proposed five quality measures for medical billing in what they call the Billing Quality 5-Star Rating System.

"Given the wide variation in both pricing and collection practices by hospitals, measures of billing practices are needed," the authors stated in the JAMA article. "Billing quality is a type of medical quality."

They hope that their proposal will be "the first step toward achieving the goal of national billing quality standards," Mathews, assistant professor of medicine and head of clinical innovation at Johns Hopkins Medicine's Armstrong Institute for Patient Safety and Quality, said in a statement.

The five measures are:

  1. Itemized bills: Are patients routinely provided an itemized bill with items explained in plain English?
  2. Price transparency: Are patients provided real prices for common "shoppable" services when they ask?
  3. Service quality: Can patients speak with a billing representative promptly about a concern they have about their bill and be informed of a transparent review process?
  4. Suing patients: For patients who have not entered into a written agreement specifying a price for a medical service, does the institution sue patients to garnish their wages, place a lien on their home or involuntarily withdraw money from a patient's income tax return?
  5. Surprise bills: Are out-of-network patients paying out of pocket expected to pay more than the region-specific, reference-based price [a price outside of that set by traditional insurance carriers]? Are patients billed for complications stemming from National Quality Forum (NQF) serious reportable events?

"In recent years, patient care and outcomes have been significantly improved by applying quality science to medicine, benchmarking the performance of both health care providers and facilities, yet there are no standardized metrics for billing quality," Makary, professor of surgery at the Johns Hopkins University School of Medicine and an authority on health care quality, said in a statement.

Read the full Viewpoint article here.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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