Predictions for medical billing in 2021

February 23, 2021
By Terry Rowinski

Add ‘medical billing’ to the list of healthcare practices forever changed by the COVID-19 pandemic.
Just as we’ve adjusted to new health and safety protocols, new modes of communication and new ways of working, medical billing practices have changed to adapt to our new normal.

While there may be an end in sight for the pandemic, what we’ve experienced this past year will be etched in consumers’ minds for decades to come. It will continue to influence our decisions about who we decide to trust with our care and how we find them.

Terry Rowinski
Here’s how medical billing has changed over the past year and what we can expect in 2021.

Transparency in medical billing is no longer optional
Lawmakers took the opportunity to show how seriously they’re taking healthcare transparency when drafting coronavirus relief packages: the Coronavirus Aid, Relief, and Economic Security (CARES) Act required providers of diagnostic tests to make the out-of-network cash price of a COVID-19 test publicly available on their website. This regulation has already unearthed the questionable (and not uncommon) business practices that ultimately harm consumers.

Although a global pandemic certainly forces the issue, COVID-19 isn’t the only reason regulators are looking at transparency. Medical billing and healthcare costs have long needed an overhaul in favor of the employers who provide benefits and their employees who utilize them.

As of January 1, 2021, hospitals are implementing a 2019 CMS transparency rule requiring them to provide clear and accessible pricing information about their items and services. CMS also issued a final rule on healthcare price transparency for insurers. Over the next few years, health plans will have to provide an online shopping tool allowing consumers to view a personalized estimate of their out-of-pocket cost for shoppable items and services. The tool will also show consumers the negotiated price between their provider and their plan.

Consumers will change how they shop for healthcare
The next step is encouraging consumers to utilize this new transparency. Having prices made publicly available doesn’t have a big impact unless consumers know how to access and use that information. They need to feel empowered to shop for their healthcare—something they aren’t used to doing.

Historically, consumers haven’t been able to shop for healthcare the same way they shop for virtually any other product or service in a consumer-based economy. Consumers haven’t been trained to compare the best prices for their healthcare provider because they previously haven’t had upfront access to pricing information.

Consumers need two pieces of information to make the best decisions about their healthcare: price and quality. These two factors are often conflated; we tend to assume (sometimes falsely) that the more expensive something is, the higher its quality. That’s certainly not always the case in healthcare, but when it comes to making a decision about who to trust with their health, consumers are willing to pay a premium (if they can afford to) in exchange for quality care.

That’s why presenting both pieces of information is so critical. Once accurate, easy-to-read pricing information is readily available, price will become yet another factor that helps consumers make informed decisions about healthcare services and providers. When consumers can compare prices between providers, providers will then need to justify why their price differs from the provider across town (i.e. demonstrate quality).

The consumer revolution will continue
Whether it’s ordering take-out from an app or visiting the doctor virtually, consumers have spent the past year expecting the institutions they interact with to provide digital, easy-to-use experiences. Tasks like booking appointments, paying bills and contacting customer support with questions should be simple.

When selecting a provider, consumers will consider a variety of factors, including quality, cost, transparency and user experience. The user experience spans the entire interaction with the provider, from booking an appointment through to finalizing payment. Expecting a smooth, easy experience isn’t going to change once the vaccine rolls out. Providers who aren’t willing to provide strong customer support throughout the treatment process won’t retain their patients.

Finally, as we settle into a post-COVID world and once insurers aren’t waiving costs as a courtesy, the cost burden is going to shift back to the employer and patient/consumer. After such an unprecedented year, and considering how drastically it affected healthcare, consumers won’t be willing to return to rising prices, frustrating bills and lack of transparency. They will demand easy-to-understand billing practices that allow them to take control of their healthcare spending.

The past year has been one of challenge, change and reckoning in the healthcare industry. The status quo is no longer acceptable when it comes to how we bill patients for care. Our goal for the next year (and beyond) is to implement transparent, consumer-centric practices that put patients—not billing—first.

About the author: Terry Rowinski is the CEO of Health Payment Systems.