In an effort to adapt to the Patient Protection and Affordable Care Act and as a reminder that hospitals must address billing issues in a "timely, transparent and forthright manner," the American Hospital Association released updated guidelines (pdf) on hospital billing and collection practices.
Under the PPACA, non-profit hospitals must conduct community needs assessments, clearly state financial aid policies and follow other billing procedures in order to keep their tax exemptions.
The AHA originally adopted billing and collections guidelines in 2003 but has since updated it to conform to the times. Some of the AHA's main guidelines include the following:
• Hospitals should communicate effectively and provide financial counseling to patients about their hospital bills, and they should make the availability of such counseling widely known.
• Under the PPACA, hospitals should instill a written financial assistance policy that includes eligibility criteria, the basis for calculating charges and the method for applying for financial assistance. Hospitals should also widely publicize through website, direct patient contact or other means these policies and share them with the appropriate health and human services agencies.
• Hospitals should have policies to limit charges for emergency and other medically necessary care for those who qualify for financial assistance to no more than the amounts generally billed to insured individuals. Hospitals should also review all current charges to make sure they are reasonable in both cost and community need.
• Hospitals should ensure that patient accounts are pursued fairly and consistently, and they should have a written collections policy that explains what happens in the event of nonpayment.
Hospital billing practices came under scrutiny in April after Minnesota Attorney General Lori Swanson filed suit against Accretive Health, a debt collection agency. The lawsuit claimed Accretive, whose clients included Fairview Health Services in Minneapolis and North Memorial Health Care in Robinsdale, Minn., pressured patients to pay medical bills out of pocket before receiving care.
Under the PPACA, non-profit hospitals must conduct community needs assessments, clearly state financial aid policies and follow other billing procedures in order to keep their tax exemptions.
The AHA originally adopted billing and collections guidelines in 2003 but has since updated it to conform to the times. Some of the AHA's main guidelines include the following:
• Hospitals should communicate effectively and provide financial counseling to patients about their hospital bills, and they should make the availability of such counseling widely known.
• Under the PPACA, hospitals should instill a written financial assistance policy that includes eligibility criteria, the basis for calculating charges and the method for applying for financial assistance. Hospitals should also widely publicize through website, direct patient contact or other means these policies and share them with the appropriate health and human services agencies.
• Hospitals should have policies to limit charges for emergency and other medically necessary care for those who qualify for financial assistance to no more than the amounts generally billed to insured individuals. Hospitals should also review all current charges to make sure they are reasonable in both cost and community need.
• Hospitals should ensure that patient accounts are pursued fairly and consistently, and they should have a written collections policy that explains what happens in the event of nonpayment.
Hospital billing practices came under scrutiny in April after Minnesota Attorney General Lori Swanson filed suit against Accretive Health, a debt collection agency. The lawsuit claimed Accretive, whose clients included Fairview Health Services in Minneapolis and North Memorial Health Care in Robinsdale, Minn., pressured patients to pay medical bills out of pocket before receiving care.
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