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BBT Ep. 18: Elephant Ears & Healthcare

August 24, 20237 min read

In this episode we cover an article from The Minnesota Reformer detailing a hospital that is turning away patients if they have too much unpaid medical debt.

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 Welcome to the Better Billing Today podcast. I'm your host, Adam Welchel from Spark Billing Services. On this podcast, we're talking to owners, operators, and their staff of small clinics and practices just like yours. Helping you streamline operations, improve your cash flow, and creating a positive patient financial experience.

On this podcast, we're talking about hiring, training, software compliance, and changes in the industry so that you can continue to run your practice instead of it running you. Today we have Chris, our producer at the Controls.

Hello, and you can see all of our episodes and find us on your favorite podcast platform at Send in your questions, stories, and more at Back to you, Adam.

Minnesota reformer

Thanks, Chris. Today, we're talking about billing practices and the fine line between better business practices and ethical responsibilities. Can hospitals and doctors turn away patients because they owe them money?

A hospital in Minnesota has done just that. The New York Times did an investigation and the attorney general Keith Ellison was looking into investigating Alina Health, the largest nonprofit healthcare provider in Minnesota. This hospital began telling patients that if they owed more than $4,500, that they would turn them away for non-emergency.

It's unclear whether this particular hospital is denying care to patients and violating a hospital agreement. The CEO says they're not in violation of any hospital agreements and during this investigation they have paused the practice of denying care in non emergency situations to patients who owe the hospital more than $4,500.

The Attorney General is even going to host a medical billing themed booth. at the Minnesota State Fair at the Attorney General's office booth. And of all the topics that the Attorney General could be working on and addressing with the community and reaching out to Minnesotans, medical billing is the top issue that they are talking about in Minnesota right now.

So you can come ride the Ferris wheel and talk about your health care at the same time. Is that right, Adam?

I guess you can, I guess you can get some elephant ear and talk about medical billing issues, candy corn. Yeah. And there may or may not be a connection between those two topics. The attorney general is also going to be hosting listening sessions in St. Paul and Rochester, really getting in front of the people, opening the floor and actually meeting with them in the same room to discuss these issues in person.

So it sounds to me they're really taking this seriously and they want to hear from the patients that have been affected and their families and really wondering what they're going to do if the hospital is not in violation of their hospital agreement and what is stopping a hospital from drawing a line in the sand when medical debt gets too high?

The medical billing issues that face Minnesota and every other state right now is not going to be fixed with more and more charity and more and more regulation or step it, step in from the Attorney General's of each state, but it's, more reflective of the root cause issue of the entire healthcare system and our billing practice, our reimbursement practices, our cost.

Really just the picture of health for our nation. We are one of the sickest countries In the world, and we also have one of the sickest billing practices and billing systems on the planet.

The link to the government website citing the listening sessions and more information states that in 2023, the Minnesota legislature passed Walz signed a bill into law requiring that hospitals post notice of the availability of charity care in various locations and languages throughout the hospital facility. They require that hospitals screen uninsured patients and patients whose insurance status is unknown, requiring hospitals to assist eligible patients, barring hospitals from imposing an unreasonable burden on patients and prohibiting hospitals from engaging in various types of collection efforts before first determining whether the patient is eligible for charity care.

Yeah, that's a lot of administrative burden for the hospital to Jump through a lot of hoops. They have to jump through Administratively and a lot of decision trees, it's if this then that but maybe this maybe that maybe not and a lot of fact finding just to see if they can collect money from the patient charge the patient directly or get them in touch with a charity care that will help them pay that bill.

It would be one thing if these were the elective policies of any given hospital. This is now the burden placed on all hospitals in Minnesota by law.

Yeah, if this is actually a law and not just a policy that the hospitals have now, all of the hospitals in Minnesota have to start changing their practices, modifying their administrative workflows to account for these hurdles and these financial assistance programs that the patients may qualify for.

But overall, this is consistent with what we've been seeing in the last few episodes that we've been covering on the deterioration of the medical billing industry as a practice, not even as an outsourced industry, but as a practice, what it takes to collect money from a patient the barrier to collection has a while a hurdle or a wall or a boulder, whatever that is, it has doubled and tripled in size in the last five years or so.

And we've yet to cover any articles that target the insurance companies as the ones who should be required to lower that barrier to reimbursement. Now, we're going to keep looking for them, but there's definitely not been as much noise about the insurance companies being held accountable to participating in this reimbursement process and making sure that the patient is at the center of their of their operation and not the shareholders of these insurance companies, but we can definitely see a shift towards adding AI and making, charity care an integrated part of the process and not calling the patients too much because we don't want to, overburden them with medical debt and collection efforts.

But where is the insurance company in all of this and where's the accountability that they actually shouldn't be blindly just denying claims and failing to reimburse providers at an appropriate turnaround time? And then where's the requirement for them to make sure that they're training their staff so that they're knowledgeable on policies and best practices and able to help the provider get reimbursed in a timely manner without too much administrative burden put on the provider?

The whole thing is sick and disgusting and broken and Spark Billing Services does take on some of that burden for our providers. But, it's important for us to know what's, What's going on in the industry and making sure that you're aware of some of the burdens that are going to come in your direction if you're a medical biller, if you're a revenue manager, if you're a doctor and even if you're a patient listening to this podcast, if you are involved in medical billing in some way, if you're involved in this process at all there's a lot happening in this industry. And this podcast, Better Billing Today is here to keep you updated, informed, educated, And hopefully proactive against some of these things that are coming against our industry.

So I'd love to hear from you office at Please send us your questions, concerns, comments, and articles, and we'll be sure to bring them up on the show. If you want to be a guest on our show, if you're a professional in the industry, we'd love to have you on the show and talk to you about what you're seeing and some of the best practices that you've implemented in your practice to make the patient financial experience the best it can be. Once again, this has been another episode of the better billing today podcast. I'm your host Adam Welchel from spark billing services. Have a great day!


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