In an effort to help address the growing national problem of rising health costs and overwhelming medical bills, two physicians at Johns Hopkins Medicine, have proposed five quality measures for medical billing, as detailed in an article in The Journal of the American Medical Association (JAMA). Currently there are no standardized metrics for billing quality, and the proposed metrics would be the first step toward achieving the goal of national billing quality standards.
The Billing Quality 5-Star Rating System proposed includes the following measures:
- Itemized bills – Are patients routinely provided an itemized bill with items explained in plain English?
- Price transparency – Are patients provided real prices for common “shoppable” services when they ask?
- Service quality – Can patients speak with a billing representative promptly about a concern they have about their bill and be informed of a transparent review process?
- Suing patients – For patients who have not entered into a written agreement specifying a price for a medical service, does the institution sue patients to garnish their wages, place a lien on their home or involuntarily withdraw money from a patient’s income tax return?
- Surprise bills – Are out-of-network patients paying out of pocket expected to pay more than the region-specific, reference-based price [a price outside of that set by traditional insurance carriers]? and Are patients billed for complications stemming from National Quality Forum (NQF) serious reportable events?
- John Hopkins Medicine: https://www.hopkinsmedicine.org/news/newsroom/news-releases/johns-hopkins-physicians-propose-quality-measures-to-improve-medical-billing
- Billing Quality Is Medical Quality. Journal of American Medical Association. February 4 2020