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  1. Family Finance

Methodology: Best Hospitals and Surgery Centers for Billing Ethics

By:
Money Staff
6 min read
- Money; Getty Images
Money; Getty Images

The Leapfrog Group is a nonprofit organization that aims to help consumers make informed decisions about their health and access safe, high-value care. For over two decades, it has collected and published data on patient safety and quality of care from voluntary surveys and other sources. More than 2,200 hospitals and surgery centers completed its flagship Leapfrog Surveys in 2022.

To compile its new list of the best hospitals and surgery centers for ethical billing practices in partnership with Money, the Leapfrog Group used data submitted via the 2022 Leapfrog Hospital Survey and 2022 Leapfrog Ambulatory Surgery Center Survey, which participants were required to submit by August 31, 2022.

To qualify for the list, eligible hospitals were required to carry an A or B letter grade on the Leapfrog Hospital Safety Grade assessment for fall 2022. Both hospitals and surgical centers were also required to meet certain standards of billing ethics.

The 565 hospitals and 10 surgical centers that made the cut are a combination of adult and children’s hospitals, urban and rural, teaching and non-teaching, and single and multi-speciality surgery centers, etc.

For more information on Leapfrog’s standards, visit Leapfrog’s hospital and surgery center survey measure page.

For the complete methodology, read below.

For the Best Hospitals and Surgery Centers for Ethical Billing Practices list, the following criteria were applied:

I. Billing Ethics: A hospital or surgery center must achieve Leapfrog’s standard for Billing Ethics

Billing quality is health care quality. Hospitals and surgery centers should strive to ensure their process for billing patients adheres to the highest ethical standards. This measure assesses whether hospitals and surgery centers have taken the following steps to ensure ethical billing:

1. The hospital or surgery center provides every patient with a billing statement and/or master itemized bill within 30 days of final claims adjudication that includes all of the following elements:

b. Date(s) of service

c. An individual line item for each service or bundle of services performed

d. Description of services billed that accompanies each line item or bundle of services

e. Amount of any principal, interest, or fees (e.g., late or processing fees), if applicable

f. Amount of any adjustments to the bill (e.g., health plan payment or discounts), if applicable

g. Amount of any payments already received (from the patient or any other party), if applicable

h. Instructions on how to apply for financial assistance

i. Instructions on how to obtain a copy of the bill in the patient’s primary language

j. Notification that physician services will be billed separately, if applicable

2. The hospital or surgery center gives patients instructions for contacting a billing representative who has the authority to initiate an investigation into errors on a bill, review, negotiate, and offer a price adjustment or debt forgiveness based on facility policy and establish a payment plan, within 5 business days

3. The hospital or surgery center does not take legal action against patients for late or insufficient payment of a medical bill

4. The surgery center provides either payer-specific negotiated charges or cash prices on their website for commonly performed procedures

To meet Leapfrog’s standard, the hospital or surgery center must do all three of the above. For more information, click here.

High medical prices and billing practices may reduce public trust in the medical profession and can result in the avoidance of care. In a survey of 1000 patients, 64% reported that they delayed or neglected seeking medical care in the past year because of concern about high medical bills.[1]

II. Hospitals eligible for a Leapfrog Hospital Safety Grade must receive an A or B on the letter grades publicly reported at the time of the Best Hospitals for Ethical Billing Practices public announcement.

Note: This criterion does not apply to surgery centers or hospitals that are not eligible for a Safety Grade, such as military treatment facilities, specialty facilities, critical access hospitals, etc.

The Leapfrog Hospital Safety Grade assesses how safe hospitals are for patients. Each A, B, C, D or F score comes from expert analysis of publicly available data consumers can use to protect their families from harm or death during a hospital stay. Some hospitals are exempted from receiving a Safety Grade, including specialty hospitals like children’s or surgical, and Critical Access Hospitals. Hospitals that are eligible for a grade, which includes general acute-care hospitals, must receive an A or B on the current Leapfrog Hospital Safety Grade (fall 2022) in order to qualify for the list of Best Hospitals for Ethical Billing Practices.

[1] Heath S. 64% of patients avoid care due to high patient healthcare costs. Patient Engagement HIT website. https://patientengagementhit.com/news/64-ofpatients-avoid-care-due-to-of-high-patienthealthcare-costs. Published February 2018. Accessed November 1, 2019.