Predictions for medical billing in 2021

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Predictions for medical billing in 2021

January 04, 2021
Business Affairs
Terry Rowinski
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.

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

Transparency will be the standard
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. Government agencies are responding by enacting additional laws designed to better inform consumers of their healthcare costs.

Starting January 1, 2021, hospitals will begin implementing a 2019 Centers for Medicare & Medicaid Services (CMS) transparency rule. Hospitals will need to provide clear and accessible pricing information about their items and services in two formats:
1. A comprehensive machine-readable file with all items and services
2. An online display of shoppable services in a consumer-friendly format

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.

These rules are the result of a larger movement towards increased transparency in medical billing, one that began well before 2020 but became critically important amid the coronavirus pandemic.

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