Surprise Medical Bills Lead Patients to Change Hospitals

Patients who receive surprise medical bills are more likely to change hospitals than those who do not, a new study has found.

According to an analysis of behavior by obstetrics patients,

…11 percent of mothers experienced a surprise out-of-network bill with their first delivery, and this was associated with an increase of 13 percent in the odds of switching hospitals for the second delivery, compared to mothers who did not experience a surprise bill.

The study found that this switching often paid dividends for those who switched:

Mothers who switched hospitals after a surprise out-of-network bill reduced their relative risk of receiving a second surprise medical bill by 56 percent, compared to mothers who did not switch after receiving their first surprise bill.

NASH staff recently met with staff of the Senate Health, Education, Labor and Pensions (HELP) Committee to share private safety-net hospitals’ views on this emerging issue.

Learn more about the implications for hospitals when they send surprise medical bills in the Health Affairs study “Consumers’ Responses to Surprise Medical Bills in Elective Situations.”

Feds Provide More Info on Short Stay Settlement Offer

The Centers for Medicare & Medicaid Services (CMS) has posted more information about its offer to settle hospital appeals of Medicare denials of payments for short hospital stays.

The offer, made last week, seeks to help CMS with an 18-month backlog of hundreds of thousands of appeals from acute-care and critical access hospitals.  Hospitals willing to drop their appeals are eligible to receive 68 cents on the dollar for the value of the cases in dispute.  The offer is available only for cases in which Medicare’s auditors rejected hospital claims for inpatient reimbursement for short hospital stays and then categorized the cases in question as outpatient care.  Hospitals that wish to take advantage of the CMS offer must drop their claims for all such cases; they cannot selectively choose to drop some appeals and continue to pursue others.

cmsNow, CMS has outlined how the process of filing for settlement of the cases will work, including the information hospitals must provide and the format in which they must provide it, the forms they must use, and descriptions of the processes it will employ to address discrepancies and reconcile claims.

CMS also has posted an FAQ, a recording of a teleconference on the subject, and the email address for questions.

Learn more about CMS’s offer and this process and find the materials cited above and additional documents available for download in this announcement on the CMS web site.