Payers face higher rates due to provider billing fights, new survey finds

Medicine Money
Billing disputes spill over and affect healthcare payers, a new survey finds. (Getty/utah778)

While billing is primarily believed to be a provider-payment issue, a new survey finds that complications are spilling over and affecting payers.

Patient billing collections has caused providers to negotiate for higher rates from insurers, according to a new survey conducted by HIMSS of providers and payers. The survey, sponsored by the billing management startup OODA Health, comes as Congress is pondering ways to tackle surprise billing.

The survey found 67% of the 39 hospitals and health systems queried use patient collections as a “justification for rate increases in payer negotiations, with 21% using it prominently,” according to a white paper on the results. “This indicates that nonpayment is at least partially baked into the negotiated rate, prompting payers to cost-shift to the patient further in an effort to curb medical trend and keep premiums low.”

The paper added that actual data on what patients pay aren’t available to health plans.

“As a result, payers design plans based on what patients owe rather than what patients pay,” the authors said.

RELATED: Payer groups form coalition to push surprise billing reform

The survey also explored what consumer insights payers would like to get as feedback on their plans.

A majority (63%) of the 27 survey respondents who all worked at insurers or third-party payers said they want to know how plan complexity could affect consumer comprehension of a plan and healthcare utilization.

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“Payers would benefit from additional insights into how members experience and respond to their benefit designs—insights that, to date, have been primarily visible to providers,” the paper said.

The lack of insight is a concern, as a majority of those surveyed said that member satisfaction at least moderately drives plan design and pricing.

RELATED: Hospitals, doctors raise alarm over surprise billing legislation advanced by Senate lawmakers

The U.S. House and Senate are working on legislation to tackle surprise billing. The Senate Health, Education, Labor and Pensions Committee passed legislation that pays doctors and hospitals out of a patient’s network a median contracted rate.

The House Energy and Commerce Committee advanced to the full House legislation that creates an arbitration option, which providers have been pushing for. Neither piece of legislation has passed, as Congress is in recess until next month.