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Predictions for medical billing in 2021

February 23, 2021
Business Affairs
From the January/February issue of HealthCare Business News magazine

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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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.

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