As insurance deductibles rise and patients pay more of their healthcare bills out of pocket, some hospitals and other providers are notifying patients of so-called "split billing."
Split billing occurs when a patient receives services that go beyond the scheduled visit, such as when a provider addresses an acute medical issue during a patient's annual physical or preventive service exam. For example, if a physician finds a polyp and removes it during a patient's routine colonoscopy, the patient may incur additional charges because the polyp removal was therapeutic rather than preventive.
Alerting patients
To alert patients of the potential for split billing, some healthcare providers are doing outreach about patient financial responsibility and helping people understand their coverage.
At Winston-Salem, N.C.-based Novant Health, patients are notified up front about split billing via MyChart, an online portal that allows patients to manage and receive information about their health.
"We're an Epic customer so we have a very robust MyChart utilization with almost 1 million utilizing MyChart actively," said Marty Lambeth, vice president of physician network services at Novant. "If we have a patient schedule an annual physical or one of the Medicare wellness visits, we will push out information to them in advance through MyChart to let them know what the wellness visit encompasses and that if there are additional services that are provided there may be additional costs."
Novant also created a standardized letter that clinic staff could use to notify patients about split billing, and the system includes a tagline on billing statements if the provider addressed a chronic condition or acute problem during a wellness exam.
"It's trying to provide as much information as we can to the patient and also explaining the 'why,'" Ms. Lambeth said.
But she contends the most valuable tool is a provider discussing these issues with patients and giving them the option to address their chronic or acute conditions during a separate visit.
Novant isn't alone. Healthcare providers in South Carolina have also notified patients of split billing. Charleston, S.C.-based Roper St. Francis sent a letter to patients saying they should anticipate additional charges if a physician addresses pre-existing conditions during an annual visit.
Additionally, Yvonne Dailey, owner of Dailey Billing Services, a medical billing services company serving clients in New Jersey, Pennsylvania, Illinois, Tennessee, Virginia, Georgia and Utah, said some providers use posters to inform patients about split billing.
"I just feel that there should be very visible posters and handouts to demonstrate this to patients," she said, adding that it's also important for patients to educate themselves on the provider's policies and to communicate effectively with their provider and the billing department.
Contributors to split billing
Split billing has been an issue for years, but it is occurring more frequently, primarily because of high-deductible health plans, according to Ms. Lambeth.
Overall, she said, patients seek more value out of each visit because they are paying more out of pocket.
"Patients began saving up their questions or issues around their chronic disease management and try to just pack it in to their annual wellness visit to avoid out-of- pocket expense," she said.
Richard Gundling, senior vice president of healthcare financial practices at the Healthcare Financial Management Association, agreed that high-deductible health plans have made split billing more common. He adds that patients also may not fully understand which preventive services must be provided at no charge to them under the ACA.
"Depending on the service, there are different deductibles, coinsurance and differences between preventive and diagnostic, and to the average person, that might seem kind of a blurry line," said Mr. Gundling. "There are opportunities for both health plans and providers to help patients understand their coverage, both when procedures are scheduled in advance and at the time of service. That's an important way to help patients make more informed decisions about their care."
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