New HFMA guidelines call for early provider-patient talks on bills

(Story updated at 7:30 p.m. ET with comment from HFMA President and CEO Joseph Fifer.)

Responding to heightened scrutiny of hospital billing and collection practices, the Healthcare Financial Management Association on Sunday released new guidelines aimed at improving provider communications with patients about paying for care.

The proposed guidelines come more than a year after a Minnesota attorney general investigation of Accretive Health, a publicly traded revenue-cycle management firm, for alleged violations of patient privacy and consumer protection laws while pursuing patients for non-payment of bills owed several regional hospital chains. A settlement agreement forced Accretive to cease doing business in the state.

Accretive said in May 2012 that it would fund a panel to draft patient collection standards but had not yet selected a partner to develop the guidelines. Co-founder and former CEO Mary Tolan served on the steering committee for the HFMA initiative.

HFMA President and CEO Joseph Fifer acknowledged that Accretive “got the ball rolling,” but denied that the action in Minnesota spurred the new standards. “It was never part of our conversation,” he said.

The group released the guidelines at the start of its Annual National Institute in Orlando, Fla., and will accept public comments through July 31. The group hopes healthcare organizations will adopt the voluntary guidelines beginning in the fall.

In introducing the guidelines at the meeting, Fifer cited the greater focus on healthcare prices and the push for transparency. He added that these issues will continue to be in the spotlight as patients take greater responsibility for healthcare costs.

The guidelines aim to set the stage for billing-related conversations both inside and outside the emergency department as well as in advance of services. They address points such as when and where to initiate a financial discussion, who should conduct the conversation, how to proceed when a patient has an outstanding balance and how to measure compliance.

Fifer noted in an interview that the recommendations build on previous standards set by HFMA and the American Hospital Association about a decade ago and add a new level of specificity. “Things have changed since then,” he said. “There's basically a cry coming from the industry for more details.”

The guideline development project enlisted a number of high-profile advisers, including Sens. Tom Daschle (D-S.D.) and Bill Frist (R-Tenn.), former HHS Secretary Donna Shalala, former Utah Gov. Michael Leavitt and attorney Jamie Gorelick.

A steering committee, working in conjunction with healthcare consulting firm Leavitt Partners, consisted of 15 representatives from provider organizations, revenue-cycle management firms, academia, and patient advocacy and industry groups.

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