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.

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.

Consumers will change how they shop for healthcare
The recent legislation requiring transparency from both providers and payers is only one part of the equation. The next step is changing consumer behavior to encourage them to utilize that information. 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 are given limited options (if any) for choosing an insurance provider and are further limited to only seeing a provider within their network (or else face a higher co-pay). 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). Developing an infrastructure to better educate patients on what their treatment entails and why it costs what it does will not only create a more informed patient but also help to create a stronger business case for the provider.

Rather than blindly choosing a provider, consumers will feel empowered to be intentional with the provider they choose for their family.

The consumer revolution will continue
We can empower patients by meeting them where they are. Not only do they need transparent and accurate information about pricing, but they also need the right channels to find a provider, understand their coverage and benefits, and make payments.

As a result of COVID-19, consumers quickly learned to use new technologies and processes to abide by social distancing requirements. 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.