By Joshua Silver,  VP, Product Development

Buried deep in North Carolina House Bill 834 (ratified on July 25, 2013) are several provisions which hospitals and physician groups practicing in North Carolina need to be aware of.  The bill comes as a result of rising consumer confusion and frustration with healthcare billing practices.

Three provisions of the bill are of particular interest to me, since Patientco has long been educating healthcare providers all across the country about these very same challenges.  Here are some best practices:

1.  Bill clarity

[Bills must detail] in language comprehensible to an ordinary layperson the specific nature of the charges or expenses incurred by the patient.

After spending several years in hospitals around Patient Account Reps (PARs) and Customer Service Representatives (CSRs), they tell me that two of the most common patient questions/gripes they hear are “What was this charge for?” or “I can’t believe I got charged for X!”

And when patient statements list charges like “VNPCTR” or “Exc S/N/H/F/G Mal+Mrg 1.1-2.0” instead of “Blood draw” or “Removal of malignant lesion,” it’s no wonder that patients are confused.   I’ve seen some descriptions so cryptic that even the billing staff can’t provide a solid answer as to what the procedure actually was.

With all of the confusion surrounding healthcare bills, EOBs (Explanation of Benefits), deductibles, in-network and out-of-network charges, etc., patient statement design / procedure terminology is the one thing that sits solely in control of the hospital.

BEST PRACTICE:  Make sure you actually review patient statements periodically to assess how patient friendly the descriptions really are.  Is it clear to a layperson what a particular line item is for? Is it likely that patients who had that procedure done would call it the same thing you would?

Ideally, your statement vendor should provide a self-service tool which allows descriptions to be changed as needed – without IT’s help and without making it a project.  By decoupling what shows up on the bill from the HIS chargemaster, the Revenue Cycle team is empowered to respond to patient confusion, rather than hindered by legacy HIS dictionaries, etc.

2. Archival time

A patient may request an itemized list of charges at any time within three years after the date of discharge.

Make sure that your statement vendor provides at least a 3 year archive of all statements sent out – and with the cost of cloud storage dropping everyday, this is not something that you should be charged extra for.

Since your print/mail vendor is likely applying address corrections, formatting the document, and massaging the data generated by the HIS, its important that the archive contains an exact PDF of what was sent to the patient – NOT just a re-rendered approximation.   Nothing is more frustrating as a patient that not being able to get a simple answer to the question “What am I being billed for on line 4 of the statement dated January 1st?”

BEST PRACTICE – Anyone who interacts with patients regularly should have access to the statement archive, not just a manager or two.  Having access to the patient’s entire statement history (and the complete content of each statement, not just a system note stating that one was dropped) helps provide context around a patient’s questions and payment history.

 3. Patient Refunds

If a patient has overpaid  … the hospital or ambulatory surgical facility shall provide the patient with a refund within 45 days of receiving notice of the overpayment.

As one of the lowest value functions (since you are actually returning patient money, rather than collecting it), refunds are the bain of most hospital accounting departments. The refund process is almost universally a very manual, expensive, and time-consuming task that leaves neither the patient nor provider happy.  In particular, patients who pay with a credit/debit/HSA/FSA card are often furious when they find out that their payment (which took “only a split second” to process the first time) must be refunded with a check in 4-6 weeks.

Additionally, many healthcare providers have gotten burned by spurious chargebacks due to the lengthy refund process. When a patient pays with a credit/debit/HSA/FSA card, it’s very important that the refund be issued using the same payment form (rather than cutting a check).  While accounting departments tend to avoid electronic refunds (under the auspices of tighter control, auditability, etc.), they are actually exposing themselves to greater risk by using checks for refunds in this situation.

You see, credit cards give consumers 6+ months to dispute charges.  So a frustrated patient may request a refund, deposit the refund check, and then dispute the transaction with their card issuer.  If the hospital is unsuccessful at winning the chargeback, now the patient has the amount of the refund check AND the amount they won in the dispute. In this situation, the hospital has little recourse to getting their actual money back.

BEST PRACTICE – Once proper approvals have been obtained, use a web-based tool for issuing credit card refunds – and always refund back to the same card used for the original payment.  Good refund tools allow for “one-click” refunds and require an approval note to be added for tracking / reporting purposes.  Refunds should be processed on a daily basis rather than just once a month.

Overall, these best practices not only help ensure compliance with the new laws, but more importantly improve patient satisfaction.