How to Resolve Patient Billing Complaints

Patient billing is a core component of any health care system. Although there are departments that deal with patient accounts and billings, there are still instances when disputes over medical claims and bills arise. Seeking assistance to clarify the bills helps the patients meet their financial obligations, and it also ensures that the hospital maintains friendly relationships with its patients.

Things You'll Need

  • Copies of patient bills
  • Records of correspondence
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Instructions

    • 1

      Contact the hospital billing offices to ask them to resolve an issue arising from the bill. Present them with copies of your bill to illustrate your complaint. Communicating with the hospital first helps you clarify your patient billing concerns before filing any case against the hospital. Use the contact numbers available in the bill.

    • 2

      Report the complaint to the hospital's patient advocacy team, presenting them with copies of the bills and any correspondence between you and the billing office. The advocates will investigate what services have been provided to the patient and whether they tally with the charges indicated in the bill, and then handle the complaint accordingly with the respective departments.

    • 3

      Contact the patient's insurance carrier representative to obtain a clearer understanding of the way in which claims have been processed. Talking to a carrier representative allows you to determine whether there is a problem in billing and a means of solving it at the carrier level.

    • 4

      Talk to your regional Centers for Medicaid & Medical Services (CMS) office if the complaint cannot be resolved at the hospital or carrier level. The CMS is the federal agency in charge of Medicare, Medicaid and Child Health Insurance Programs. It also oversees contracts that Medicare has with a patient's carrier. CMS's regional offices help to resolve billing complaints when a carrier misapplies national Medicare policy.

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