ACA International and HFMA Release Best Practices for Resolution of Medical Accounts


The updated best practices build off the work of a 2014 task force and reflect an ongoing commitment to help patients resolve their medical bills.

9/17/2020 12:00

ACA International and the Healthcare Financial Management Association Medical Accounts Receivable Resolution Task Force reconvened this year to update best practices for the fair resolution of patients’ medical bills and address financial assistance policies in response to the COVID-19 pandemic.

The report reflects the task force’s consensus on the current state of best practices related to the equitable resolution of the patient portion of medical bills.

ACA and HFMA worked together on the 28-page report, which updates and extends guidance that was originally published by HFMA in 2014. The report emphasizes the importance of educating patients and ensuring that they understand the account resolution process.  

Serving on the task force are ACA’s CEO Mark Neeb, ACA’s Vice President and Senior Counsel of Federal Advocacy Leah Dempsey, and ACA members from State Collection Service Inc.: Tim Haag, president, and Steve Beard, chief business development officer.

“ACA members have been working with consumers over the past several months to help them understand their options and provide solutions to financial challenges,” Neeb said. “We greatly appreciate the collaboration with HFMA and the other partners to develop best practices for fair resolution of medical debts that document ACA members’ compassionate approach and their commitment to continue serving consumers throughout the COVID-19 crisis and beyond.”

With a focus on patient education and communication, the best practices are designed to help patients engage in their health care and become active participants in resolving outstanding accounts.

“This year was a critical time to revisit and update these best practices on behalf of health care providers and accounts receivable management companies with the goal to help consumers resolve and understand their medical bills,” Neeb said. “We know medical debt sometimes comes with added challenges and uncertainty and it is the mission of the accounts receivable management industry and its health care provider partners to work together to offer solutions, education and guidance.”

The report includes best practices for modifying financial assistance policies in response to the COVID-19 pandemic and recommended safeguards  to implement before initiating actions, such as credit bureau reporting, that some hospitals and their business affiliates may elect to pursue in accordance with account resolution policies that have been approved by the hospital’s board of directors or other authorizing body.

The framework for the best practices includes:

  • Patient-Friendly Billing – The task force’s goal was to identify a common set of account resolution best practices that align with the federal requirements.
  • Patient Education – Education should be designed to engage patients and help them understand their financial responsibility with regard to their account balance, including what it is made up of and how to resolve it.
  • Communications – Providing a clear understanding of what to expect at every stage in the process helps patients engage in their health care and become active participants in resolving outstanding accounts.
  • Price Transparency – Providing patients with access to price estimates is a core part of the education and engagement process. The price estimate allows for tangible discussion of the patient’s obligation and facilitates discussion of potential sources of coverage, financial assistance and payment plans, as necessary. When hospitals have highly reliable price estimates for scheduled services, these estimates should be provided to patients proactively.

This report emphasizes the importance of patient education early in the accounts resolution process, but educational efforts should not stop then. The best practices are for the provider or business associate to offer ongoing education to reinforce the opportunities (e.g., financial assistance, payment plans, other sources of coverage) patients have for positive account resolution. Therefore, providers and business associates must use every patient communication to engage and educate the patient about their account resolution options.

The report also covers price transparency, patient-friendly billing, health plans and working with uninsured patients, among other topics.

The report maps out the entire medical accounts receivable resolution process from preservice to post-discharge, incorporating elements from HFMA’s Patient Financial Communications Best Practices and Patient-Friendly Billing initiative. It details financial assistance policy communication requirements for not-for-profit hospitals, which the task force recommends all hospitals should follow, regardless of tax-exempt status. A section on frequently asked questions addresses the basics of the account resolution process, working with account resolution business affiliates, steps to take when initiating certain collection actions and final disposition of unresolved accounts. Appendixes include a sample public health emergency financial assistance policy, relevant legal provisions, a glossary of terms and sample consent language.

The report was developed with the support of State Collection Service.

“The creation of best practices will enable health care providers, their business partners and patients to work collaboratively, in a consistent manner, to resolve outstanding accounts,” Haag said. “Our goal is to provide empathetic, knowledgeable assistance to both providers and patients by offering all possible solutions in account resolution.”

Members of HFMA’s 2020 Medical Accounts Receivable Resolution Task Force include a diverse group of providers, consumer advocates and collection agencies.

Access the report and additional resources from the task force here:

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