How hospitals and providers can partner to prevent surprise billing
Surprise billing is a growing problem for emergency department (ED) providers and patients across the country. While surprise ED bills are indicative of systemic issues in healthcare, they are not inevitable.
Today, two-thirds of hospitals outsource their ED care. The rise in both outsourced management groups and narrow network insurance products increases the chance of surprise bills. These coverage gaps result in a financial burden to the patient as well as operational challenges and fiscal costs to the hospital and its providers.
Hospitals and providers can take collaborative steps to improve transparency and fairness for patients while ensuring that providers receive fair reimbursement that allows them to continue serving their communities.
Fixing a broken system
Opportunity exists for hospital leaders and physician management groups to leverage proven, patient-focused frameworks and processes for fair reimbursement models and transparent contracts. When these parties effectively collaborate, they create more efficient, higher-functioning hospitals that improve affordability of care while meeting patients’ clinical needs.
Vituity has virtually eliminated balance billing and out-of-network care and maintains a 2.5 percent out-of-network billing rate — a stark contrast to the national rate of 14 percent. This has been achieved with an approach that includes broad contracting across regional and national payers and legislative advocacy for transparent medical billing.
About Vituity: As a physician-led and -owned, multispecialty partnership, Vituity has driven positive change in the business and practice of healthcare for nearly 50 years. Our more than 3,500 doctors and clinicians serve over 6.4 million patients annually, spanning the entire acute care continuum, including: emergency medicine, acute psychiatry, acute neurology, hospital medicine, critical care, anesthesiology, acute care surgery, telehealth, post-acute care, and outpatient medicine.
“When all stakeholders agree on the frameworks needed for fair reimbursement models and transparent contracts, focus remains on the patient.”
LEARN MORE modernhealthcare.com/perspectives_vituity2