Cigna recently made a big change in how they will pay certain claims.
Organizations will need to stand firm on compliance and reimbursement when its revenue cycle team submits evaluation and management (E/M) claims with modifier -25 as Cigna recently dropped a new policy.
According to Cigna, it created a new policy requiring submission of office notes with all claims including E/M codes 99212, 99213, 99214, and 99215 and modifier -25 when a minor procedure is billed.
Cigna said it will deny payment for these E/M services reported with modifier -25 if records documenting a significant and separately identifiable service are not submitted with the claim, and medical groups were quick to show their frustration.
For background, the revenue cycle coding staff report modifier -25 for E/M services on the same day of another service or procedure when it is performed by the same physician or provider.
So how can revenue cycle leaders create a plan for their staff to defend these claims?
The good news is revenue cycle staff from all sections of the organization can play a part in defending the revenue for modifier -25 claims, according to a recent Part B News webinar. For example, providers must create documentation that supports the modifier, coders need to monitor private payers for new policies, and members of the A/R team will need to keep an eye on these denials.
It’s important that the revenue cycle keeps an eye on these denials, teams make sure the documentation supports modifier -25, and they are quick to appeal any of those claim denials.
Creating a template unique to this Cigna requirement will also help. Staff can then modify and use the template when documentation is provided for prepayment approval, when they respond to a request for documentation to support a claim, or when they appeal a denial of an E/M visit reported with the modifier.
If you submit claims to Cigna, you should also have a process to ensure the required documentation goes out with claims that include modifier -25. If you forget, you can expect more time and more work to get reimbursed, according to Part B News.
Another way to lessen the blow is to create a targeted approach to Cigna denials. “My denials team works by payer,” Frank Cantrell, corporate director of revenue integrity at Penn Highlands Healthcare recently said. “They know their contracts backwards, forwards, and sideways.”
Cantrell believes it’s important for his team members to be critical thinkers with a high level of understanding, which is a necessity since each payer contract has varying nuances.
One leader has found that using a targeted approach by creating contract experts is a key to warding off payer denials.
Regulatory burdens and never-ending denials are putting massive strains on revenue cycles, and revenue cycle leaders tend to look toward one culprit: the payer.
Why payers?
Even if your front, middle, and back-end revenue cycle is a well-oiled machine, payers aren’t shy about throwing a wrench in things. In fact, it’s not uncommon for payers to have complicated, multi-tiered structures and rules that seem to always be changing, regardless of their contracts.
Unlike Medicare, which has standard, heavily documented rationales and processes for denials, appeals, and audits, almost anything goes when it comes to commercial payers. Each payer organization will have different rules and processes, and payers’ manuals and bulletins aren’t always easy to locate.
New policy changes can be imposed throughout the year and in the mid-contract period, adding substantially to the administrative burden. Staying compliant with payers is never-ending, and with an already strained revenue cycle staff it can be hard to find extra hands, and money, to keep up.
What can revenue cycle leaders do?
One leader has found that using a targeted approach for denials by creating teams that work by payer has helped tremendously.
“My denials team works by payer,” Frank Cantrell, corporate director of revenue integrity at Penn Highlands Healthcare told the NAHRI Journal. “They know their contracts backwards, forwards, and sideways.”
Cantrell believes it’s important for his team members to be critical thinkers with a high level of understanding, which is a necessity since each payer contract has varying nuances.
In addition to being experts in their contracts, having working knowledge of the middle revenue cycle is also important. “One thing I’ve found to be key is that all of my individuals either have a clinical or coding background,” Cantrell says. He says having that extra clinical coding edge makes a huge difference in denials management.
Also, having staff with diverse backgrounds is especially helpful when writing appeal letters, according to Cantrell. It also helps their team know where to go when looking for answers. He appreciates that his team is able to determine when it’s appropriate for other departments to weigh in on a denial.
“At that point, we become more the facilitator than the actual one working the denial,” he says. “If it’s not specific to our wheelhouse, we’ll get it to the right department. I'd have to have a huge team to handle every nuance of a denial.”
If your organization is struggling with denials after creating a more targeted approach like this, revenue cycle leaders should explore opportunities to involve other departments. For example, IT can also support documentation efforts by incorporating feedback on how to improve template functions, EHR interfaces, the placement and function of drop-down menus, and other user experience and interface issues, according to Cantrell.
Having revenue cycle staff allocated by payer will surely help to stay abreast of the seemly ever-changing payer rules. In fact, Cigna has recently come under fire for its new policy requiring submission of office notes with all claims including evaluation and management (E/M) codes 99212, 99213, 99214, and 99215 and modifier -25 when a minor procedure is billed.
Cigna says it will deny payment for these E/M services reported with modifier -25 if records documenting a significant and separately identifiable service are not submitted with the claim.
Making sure your revenue cycle team is on top of their game is a must when it comes to payer denials.
Revenue cycle success is closely tied to the patient experience, so make sure to keep the patient in mind and up-to-date as the PHE ends this week.
This week’s end in the COVID-19 public health emergency (PHE) will affect specific patient services, such as COVID-19 treatment and telehealth services. As the revenue cycle is closely tied to the patient experience, making sure staff is well-versed in these upcoming changes will not only create a more positive patient experience, but help streamline reimbursement operations during the transition.
Front-end staff especially may be fielding ample questions as patients notice changes in coverage and reimbursement this week. So, below is a summary of frequently asked questions courtesy of Revenue Cycle Advisor that clarifies what will and will not change for certain provisions once the PHE ends.
CMS said the federal government, individual states, or insurance companies may announce additional changes in the future, but for now, here are some changes staff should be aware of.
Q: Can our patients still obtain free COVID-19 vaccines?
A: For patients with Medicare, Medicaid, or coverage under the Children’s Health Insurance Program (CHIP), vaccines will be 100% covered until “the last day of the first calendar quarter that begins one year after the last day of the COVID-19 PHE,” according to CMS. As of now, this is expected to be September 30, 2024. While Medicare didn’t list an end date for vaccine coverage, Medicaid and CHIP coverage may change after that expected date. This is when the American Rescue Plan Act of 2021 (ARPA) provision, which requires these services to be provided without cost sharing, expires. It’s unclear whether coverage will change after that point.
Many people with private health insurance will still be able to get vaccinated without paying any additional money out of pocket. However, some private plans may ask patients to pay part of the cost if they get a vaccine from an out-of-network provider.
Q: Will COVID-19 tests still be covered for our patients?
A: For people with traditional Medicare, both COVID-19 PCR and antigen tests will still be free, provided they are performed in a lab and ordered by a physician or another qualifying healthcare provider. Medicare Advantage beneficiaries can still obtain tests, but they may have to pay a percentage of the costs.
“By law, Medicare does not generally cover over-the-counter services and tests,” said CMS. “Current access to free over-the-counter COVID-19 tests will end with the end of the PHE. However, some Medicare Advantage plans may continue to provide coverage as a supplemental benefit.”
Medicaid and CHIP beneficiaries will have the same coverage for COVID-19 tests until the last day of the first quarter that begins one year after the last day of the PHE—which means coverage will continue through September 30, 2024, if the PHE ends as scheduled. After that point, changes may be made.
Private insurers may or may not charge for COVID-19 laboratory tests. Some people will still be able to get free testing depending on their coverage, but others will need to pay out of pocket.
Q: How will the end of the PHE affect our patient’s COVID-19 treatment?
A: Treatment for COVID-19 will stay the same for Medicare beneficiaries once the PHE ends.
Medicaid and CHIP beneficiaries will still be eligible for treatment under the same rules that applied during the PHE until the last day of the first quarter that begins one year after the last day of the PHE (September 30, 2024). After that, coverage may continue but could vary by state.
People with private insurance will probably not see any changes related to treatment coverage.
Q: What will happen to telehealth coverage after the PHE ends?
A: Many telehealth services will still be available to Medicare beneficiaries through December 31, 2024, according to CMS. For example, telehealth services will continue to be available for those in any location, not just rural areas. Medicare will pay for in-home telehealth visits, and telephone telehealth visits are allowed if audio and video are too challenging for the patient. CMS provided additional details about the transition here.
Coverage may vary by state for those with Medicaid, CHIP, Medicare Advantage, and private health insurance.
The COVID-19 public health emergency (PHE) is ending this week, make sure your revenue cycle staff are prepared.
More than three years after the COVID-19 PHE was declared, it is now set to end on Thursday, which will be impacting revenue cycle reimbursement.
Multiple emergency declarations and waivers that were implemented granting flexibilities to state Medicaid operations and most healthcare organizations are coming to a halt, leaving revenue cycle staff scrambling to ensure minimal disruption to their billing and operations.
Here is a look at what could be affecting your revenue cycle:
Telehealth reimbursement waivers: These waivers allowed hospitals to provide telehealth services to patients without prior authorization, and reimbursements for telehealth visits were increased. With the end of the PHE, these waivers may end, and hospitals may have to seek prior authorization for telehealth services, and reimbursements may return to pre-pandemic levels.
Waivers for Medicare coinsurance and deductible payments: During the public health emergency, Medicare waived Part B coinsurance and deductible payments for COVID-19 treatment. With the end of the PHE these waivers may end, and hospitals may have to bill patients for the coinsurance and deductible payments, which could negatively impact your organizations' patient financial experience.
Suspension of Medicare sequestration: The PHE suspended the 2 percent Medicare sequestration, which was a reduction in Medicare payments to hospitals. With the end of the public health emergency, this sequestration may resume, reducing Medicare payments to hospitals.
Reintroduction of the three-day stay skilled nursing facility (SNF) requirement: To qualify for SNF reimbursement, Medicare patients must have first spent three consecutive midnights in the hospital as an inpatient. These inpatient days must meet medical necessity requirements, and the clock starts ticking when the physician writes the inpatient order.
In order to receive proper reimbursement, revenue cycle staff should be clear on the following Medicare requirements for SNF coverage:
The patient must have completed a three-day inpatient stay
The stay must have extended through three midnights, beginning at the time the physician wrote the inpatient order
Note that time spent in observation or the emergency department does not count toward the three-midnight requirement.
For even more information, HHS released a policy roadmap detailing policies that will simultaneously end with the PHE, as well as flexibilities that have been extended for various time periods.
As the end of the PHE inches closer, revenue cycle professionals must ensure their organization is in compliance throughout the transition. Review the transition roadmap and other fact sheets to determine the timeline of flexibility expirations.
More than 100 medical associations have taken issue with a new policy from Cigna regarding claims coded with modifier -25.
Cigna is coming under fire for its new policy requiring submission of office notes with all claims including evaluation and management (E/M) codes 99212, 99213, 99214, and 99215 and modifier -25 when a minor procedure is billed.
Cigna says it will deny payment for these E/M services reported with modifier -25 if records documenting a significant and separately identifiable service are not submitted with the claim, and medical groups were quick to respond.
For background, the revenue cycle coding staff report modifier -25 for E/M services on the same day of another service or procedure when it is performed by the same physician or provider.
The medical groups, including the American Medical Association, wrote in a letter to Cigna stating that the new policy is burdensome for providers and could negatively affect patients.
“Our organizations are alarmed by the significant administrative burdens and costs for health care professionals— and Cigna—that will result from implementation of this policy. By bluntly requiring clinical documentation for all claims for an E/M service reported with modifier 25, physicians and other providers will be forced to submit an enormous number of office notes, and Cigna will be deluged with medical records,” the letter said.
The groups are urging Cigna to reconsider this policy not only due to administrative burden, but because of its potential negative effect on patients, the letter said. Instead, the groups say Cigna should partner with organizations on a collaborative educational initiative to ensure correct use of modifier -25.
The groups also questioned the guidelines Cigna used to craft the new modifier -25 policy since the CPT code description "clearly states that modifier -25 enables reporting of a significant, separately identifiable E/M service by the same physician or other healthcare professional on the same day of a procedure or other service."
This latest update just adds to the already strained provider/payer relationship.
Unlike Medicare, which has standard, heavily documented rationales and processes for denials, appeals, and audits, almost anything goes when it comes to commercial payers like Cigna. Each payer organization will have different rules and processes, and payers’ manuals and bulletins aren’t always easy to locate.
“For us, it's really about new policy changes that they try to impose throughout the year and in the mid-contract period,” Patrick Wall, vice president of revenue cycle at St. Joseph's Candler, previously told HealthLeaders.
Even when policy changes spring up out of seemly nowhere, revenue cycle leaders have agreed that sometimes the administrative burden alone is too much. For example, BCBS also recently made a substantial increase in the number of medical records it requests to pay a claim.
All this back and forth means that staying compliant with payers has been, and will continue to be, a burden on the revenue cycle workforce. With already strained staff it can be hard to find extra hands, and money, to keep up with these payers.
HealthLeaders' regulatory round up series highlights five essential governing updates that cover every aspect of the revenue cycle that leaders need to know. Check back in each month for more updates.
The revenue cycle is complex, detailed, and always changing, so staying on top of regulatory updates and latest best practices requires revenue cycle leaders' constant attention in this ever-changing industry.
In this revenue cycle regulatory roundup, there were an ample number of updates published by CMS in April, including public health emergency (PHE) updates and multiple payment rate proposals.
The fiscal year (FY) 2024 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) PPS proposed rule was released.
On April 10, CMS published a draft copy of the FY 2024 IPPS proposed rule, which is scheduled to be published in the Federal Register on May 1. CMS projects an increase in operating payment rates of 2.8% based on a projected hospital market basket update of 3.0% reduced by a 0.2% productivity adjustment. CMS projects that disproportionate share hospital payments, however, will decrease by approximately $115 million.
Other policies proposed in the rule include:
CMS is not proposing to extend the New COVID-19 Treatment Add-On Payments (NCTAP) beyond the previously established end date, which was the end of the fiscal year in which the PHE terminates. With the current plan to end the PHE on May 11, that means NCTAP would expire on September 30.
For the regular New Technology Add-on Payment (NTAP) program, CMS is proposing to move the FDA approval deadline from July 1 to May 1 beginning with applications for FY 2025. CMS is considering 19 applications for NTAP under the traditional pathway and 20 for the alternative pathway for FY 2024.
CMS proposed 395 new, 13 revised, and 25 deleted ICD-10-CM codes for FY 2024. Many of these changes apply to W codes for capturing accidents and injuries. Changes also affect codes for Parkinson’s disease, new codes for osteoporosis with pelvic fractures, additional sickle cell anemia codes, and more.
The rule also contains a variety of quality reporting program changes and changes to graduate medical education payments for training in the new rural emergency hospital provider type. CMS included a Request for Information in the rule regarding challenges faced by safety-net hospitals and ways CMS could help.
CMS published a press release and fact sheet to accompany the rule. Comments are due by June 9.
The FY 2024 inpatient psychiatric facility (IPF) PPS proposed rule was released.
On April 4, CMS released a draft copy of the FY 2024 IPF PPS Proposed Rule, which was published in the Federal Register on April 10. CMS proposes an IPF payment rate update of 1.9% for FY 2024, which is slightly higher than the proposed 1.5% increase for FY 2023.
Other proposals include an amendment to the regulations to allow hospitals to open a new IPF unit at any time during the cost reporting period as long as a 30-day advance notice is provided to the CMS regional office and the MAC. CMS included a Request for Information (RFI) regarding data CMS could collect that could be used to help inform possible revisions to payment rate calculation for FY 2025 and beyond.
CMS published a fact sheet on the proposed rule on the same date. Comments are due by June 5.
Also published was the FY 2024 skilled nursing facility (SNF) PPS proposed rule.
On April 4, CMS released a draft copy of the FY 2024 SNF PPS Proposed Rule, which was published in the Federal Register on April 10. CMS proposed a 3.7% increase to the SNF payment rate for 2024. This number incorporates the 2.3% reduction that will finish the two-year phase-in of the PDPM parity adjustment.
CMS also included a proposal regarding changes to civil monetary penalties when a facility actively waives its right to a hearing in writing in order to receive a penalty reduction. CMS said that 95% of facilities facing civil monetary penalties currently follow this process. Therefore, CMS said it would create a system in which a failure to submit a timely request for a hearing would be treated as a constructive waiver and the accompanying 35% penalty reduction would remain.
This proposal is intended to reduce the burden involved with tracking and managing written waiver requests. Other proposals in the rule include changes to PDPM ICD-10 code mappings, several quality reporting changes, and SNF value-based purchasing program changes.
CMS published a fact sheet to accompany the rule. Comments are due by June 5.
Resources were published detailing the end of the COVID-19 PHE.
On April 10, CMS updated its COVID-19 Provider Toolkit with information throughout on billing and coding for COVID-19 vaccines and antibody treatments before and after the end of the COVID-19 PHE.
The changes talk about how EUAs are distinct from and not dependent on the PHE itself, review what will happen to payment rates when the EUAs end, payment rates for providing vaccines in a patient’s home through the end of 2023, and more.
More prior authorization requirements were added for facet joint interventions.
On April 11, CMS updated its list of HCPCS codes requiring prior authorization to add facet joint interventions to that list effective July 1, 2023. Providers can start submitting the prior authorization requests on June 15 for dates of service on or after July 1.
Four hospitals were hit with major fines for not adhering to the regulation.
CMS is once again cracking down on enforcement of the price transparency rule through monetary penalties.
For noncompliant hospitals, the agency recently announced will now require corrective action plan (CAP) completion deadlines, impose civil monetary penalties earlier and automatically, and streamline the compliance process.
CMS says it conducts over 200 comprehensive reviews of hospital price transparency compliance per month, and as of April 2023, CMS has issued more than 730 warning notices and 269 CAP requests. It has also imposed civil monetary penalties on four hospitals for noncompliance.
According to CMS, the hospitals fined are:
Northside Hospital Atlanta in Georgia, fined $883,180
Northside Hospital Cherokee in Georgia, fined $214,320
Frisbie Memorial Hospital in New Hampshire, fined $102,660
Kell West Regional Hospital in Texas, fined $1127,260
Although CMS maintained its requirement that noncompliant hospitals submit a CAP within 45 days from the CAP request, it will now require these hospitals to be in full compliance with price transparency guidelines within 90 days from when it issued the request.
Previously, hospitals were allowed to propose their own completion date for CMS approval.
The No Surprises Act, which became effective last year, requires hospitals to post the prices for their most common procedures as well as offer a patient-friendly tool to help shop for 300 common services.
Unfortunately, there are still organizations are behind in adhering to this requirement.
Of the hospitals studied, 5.1% were in total noncompliance as they did not post any standard charges file, and 51.3% failed compliance because the majority of their pricing data was missing or incomplete.
While some organizations now have systems in place to help them adhere to the new rules, opportunities still exist to revisit outdated revenue cycle processes to better comply with these regulations.
Connie Lockhart, director of strategy and operations at Impact Advisors, previously discussed with Healthleaders some key strategies that revenue cycle leaders can use to increase price transparency compliance. When first shoring up price transparency processes (and as mentioned in the studies above), there are two main requirements that organizations need to adhere to immediately.
"Revenue cycle leaders need to first make sure they are following CMS' guidelines to complete a comprehensive, machine-readable file of all services and items," she says. "Ensure all requirements are met—like how a separate file must be posted for each hospital. And be cognizant of multiple hospitals operating under a single hospital license with different sets of standard charges."
Also, ensure that list is posted on a publicly available website.
Once completed, make sure to post a display in a publicly available website of 300 shoppable services in a consumer-friendly format. This should include the 70 CMS-specified, shoppable services, Lockhart says. Revenue cycle leaders should also establish a cadence to ensure both displays are updated annually, Lockhart says.
A new report calls out the risk found within the No Surprises Act, including the civil monetary penalties for each violation in which a patient receives a surprise medical bill.
A new report, “25 Top Management Risks for Healthcare in 2023,” published by Crowe LLP, outlines the leading risks internal audit professionals and compliance departments are facing at their healthcare organizations. One highlighted risk has been on the radar of revenue cycle leaders for years now: the No Surprises Act.
For the report, Crowe identified 25 top management risks facing healthcare organizations in 2023 using input from executive management and board members at many of the largest U.S. health systems. The report also used input from risk assessments conducted by the company at hundreds of health systems, hospitals, and other healthcare provider clients during 2022.
One of the biggest risks tied to the No Surprises Act is compliance and monetary penalties, the report said.
CMS has begun to audit providers and payers for noncompliance with certain requirements.
Because of the added oversight from CMS, the report says risks associated with the NSA include the civil monetary penalties for each violation in which a patient receives a surprise medical bill, and the negative reputational risks resulting in lost revenue for facilities and providers.
The report says that auditing process effectiveness and compliance can help organizations mitigate those risks.
The use of technology can also help to expand NSA risk coverage, the report says. For example, using data analytics to determine whether actual billed charges are within $400 of a good faith estimate (GFE), analyzing compliance with GFE timing requirements, and using data analytics to identify potential balance billing exceptions, are all positive uses of technology to mitigate risk.
In the report, Crowe defined a risk area as anything that might impede a healthcare organization’s ability to achieve its goals in critical areas such as patient care, regulatory compliance, operations, strategic growth, and financial performance.
To manage an environment of increasing risks and limited resources, healthcare internal audit and compliance departments must align their risk assessments and audit work plans to areas most vital to achieving the strategic goals and business objectives of their organizations. The departments must do so while staying in compliance with critical regulatory and other requirements, the report said.
One CMO plans to place a larger focus on quality and safety, patient experience, and population health.
April 23-29 is patient experience week, and HealthLeaders is helping to celebrate by spotlighting the hard work leaders put into creating a positive patient clinical and financial experience at their organizations.
Check out some of our latest stories on improving the patient financial and clinical experience that you may have missed.
The Exec: Inaugural CMO Set To 'Drive Change And Improvements'
Carolyn Kloek, MD, was recently named as the inaugural CMO of the Oklahoma City, Oklahoma-based health system. As the first chief medical officer of OU Health, Kloek plans to focus on quality and safety, medical informatics, data analytics, patient experience, digital health, population health, and process improvement.
From Appointments to Bills: Using Rev Cycle Tech To Ease Patient Burnout
When revenue cycle leaders look to ease financial burdens for their organization, there is one area that can’t be overlooked: the patients.
From the patient financial experience to the clinical experience, keeping patients happy and avoiding burnout is necessary for a thriving organization. Not only can burnout negatively impact patient experience and the quality of care they receive, patient burnout can also lead to decreased patient volume and revenue for healthcare organizations.
When it comes to technology, what can be done to remedy the patient experience and avoid burnout and lost revenue? Find the answer here.
A Sense of Purpose: Q&A With Interim Health CEO Jennifer Sheets
Before stepping into the CEO role at Interim Health in 2019, Jennifer Sheets’ career had progressed from working as a transplant ICU nurse to CEO of different hospital systems. It wasn't until two members of her family needed home health services that she realized the importance of home and community-based services to better the patient experience.
“If you drive integrated care like we do, even if the patient is not in home health but is being supported by the home care side of the business, you can still have a touchpoint and can see the progression of that patient. That really connects with clinicians who are in this to impact lives. We focus on the fact that you can have not just a job, but a relationship with your patients,” Sheets said.
When it comes to improving the patient financial experience, it's imperative to put the microscope on an organization's billing process.
April 23-29 is patient experience week, and HealthLeaders is helping to celebrate by spotlighting the hard work revenue cycle leaders put into creating a positive patient financial experience at their organizations.
At a time when a poor financial experience can negate a five-star clinical experience, revenue cycle leaders are under more pressure than ever to streamline processes for their patients. So where should organizations start when looking to improve this patient experience?
"There are quite a few challenges in the market today when it comes to a patient's billing experience," Chris Johnson, vice president of revenue cycle at Atrium Health, previously told HealthLeaders. Narrowing down those challenges and working on perfecting them will ensure a positive patient financial experience.
When it comes to a patient's bill, it's common for certain populations to find the amount of information presented overwhelming.
"Healthcare billing continues to be a complex process especially since you have the provider, patient, and payer all involved," said Johnson. "Quite frankly, when some patients see an insurer's use of CPT and ICD-10-CM codes, it can be like a foreign language, and it can cause real confusion."
Another added component seen across the healthcare industry is that patient bills still tend to show gross charges for the service or services provided to a patient.
"While gross charges are not the actual amount paid by insurers or patients, we continue to use them for billing purposes across our industry. Providers often assume patients are not concerned about gross charges, but this may not be the case." Johnson said.
"When we send a patient an itemized bill and they see their gross charges for $100,000—all of the sudden they are interested in those gross charges, not just what their actual financial responsibility is. So again, I think billing continues to be more complex than it needs to be as an industry," he said.
Price transparency has come a long way in the industry, but certain populations may need more education on what they are seeing in that final bill and breaking down this overload of information is an important step in achieving a positive patient financial experience.
Bringing that conversation forward and setting the expectation that a patient may see a gross charge or mentioning to a patient that they haven't met a deductible will help remove that surprise element from the patient's bill.
On top of this surplus of coding and pricing information, it's not unusual for patients to receive multiple bills from different providers for one episode of care.
"That can be confusing for patients. And again, it's not a problem that we have successfully fixed at this point," said Johnson.
Also, it's common for a patient's statement to not completely align with the explanation of benefits that the patient receives from their insurance company. Receiving multiple bills for one encounter as well as receiving mismatched facility and payer statements can greatly affect the patient's financial experience.
"While we are continuing to improve and provide better information to our patients, we have a more ground to cover in making this industry and process truly patient-friendly," Johnson said.
