In 2010, the Affordable Care Act (ACA) was passed to improve public health and lower healthcare costs. A cornerstone of the ACA was its emphasis on access to preventive care, including vaccinations, annual screenings, lifestyle counseling and wellness visits. The goal was to foster better health outcomes through no-cost early intervention and consequently, reduce overall healthcare expenditures over time.
The Flaws in ACA’s Execution
While the ACA’s policy on preventive care—and its aim to improve Population Health—is commendable, its real-world implementation has been fraught with challenges, especially where medical billing comes into play. The current system for medical billing is riddled with errors that impact patients and healthcare costs significantly – in fact, according to Becker’s Hospital Review, an astounding 80% of all medical bills have inaccuracies.
As a healthcare navigation company, we work with employer groups and their employees to review bills for accuracy. And unfortunately, our findings support the unsettling statistic above. Fortunately for our clients, when we spot a preventive care billing error, we’re able to work with the provider and the insurance company to quickly resolve the issue. Without such navigation services, many people find themselves grappling with these challenges alone. Which also begs the question, how many of these preventative care visits are being inaccurately billed and directly hitting the pockets of employers and their employees?
The Cascade Effect of Billing Errors on Preventive Care
Incorrect billing for preventive care treatments creates a domino effect:
- Patient Burden: Mistakes in bills push patients into a tedious cycle of verifying benefits, wasting time calling insurance companies and communicating with providers. This hassle can deter individuals from seeking essential preventive services, such as screenings or vaccines due to the fear of cost or complexity. And, more often than not, people just pay the bill because “it’s easier.”
- Employer Burden: When billing errors go unchecked, they can inflate claim costs, causing unnecessary financial strain on a company’s healthcare budget—especially those that are self-funded. And financial repercussions are just the tip of the iceberg. When an employee is faced with billing inaccuracies, the stress and complexity of resolving the issue can impact their work focus and productivity.
- Provider Burden: Billing errors and surprise bills spawn a labyrinth of follow-ups involving insurance companies, billing agencies and additional administrative overhead. This not only results in potential litigations or audits but can immediately tarnish an excellent patient experience, potentially leading to poor patient scores and negative reviews.
What’s Causing Preventive Care Billing Errors?
Most billing errors are the result of human error—incorrect or accidentally omitted codes. And those mistakes can be costly. In the scenario of a routine physical examination, if a provider identifies conditions like hypertension or hypercholesterolemia but doesn’t code the visit as a routine physical, it can inadvertently shift the financial responsibility to the patient, as opposed to being covered under preventive care benefits.
Given that 80% of medical bills contain errors, it’s safe to assume that a majority of them are inaccurate. But most individuals don’t know how or where to seek resolution. One effective solution lies in partnering with a healthcare navigation company. These specialized entities, like Emry Health, shoulder the responsibility of meticulously reviewing employee bills for accuracy. Their in-depth examination ensures that errors are caught early, minimizing the cascade of negative impacts. By working directly with both insurance companies and providers, healthcare navigators can quickly address and fix billing discrepancies, sparing patients the daunting task of navigating the intricate medical billing maze alone. Beyond individual patients, employers stand to benefit as well, as an accurate billing process reduces inflated claim costs and prevents the subsequent workplace disruptions that arise when employees grapple with billing issues.
Investing in such partnerships could be a pivotal step towards eliminating the preventable burden of billing errors in the realm of preventive care.