Complex Billing for Nonemergency Outpatient Imaging: An Obstacle to the Success of Health Care Price Transparency Initiatives |
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| Institution: | 1. Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia;2. Department of Radiology and Imaging Sciences, School of Medicine, Emory University, Atlanta, Georgia;1. Resident, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio;2. Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Medical Student, Case Western Reserve University School of Medicine, Cleveland, Ohio;3. Medical Student, Case Western Reserve University School of Medicine, Cleveland, Ohio;4. Director, Strategic Planning and Analytics, University Hospitals Cleveland Medical Center, Cleveland, Ohio;5. Cancer Informatics Senior Data Architect, Cancer Informatics, University Hospitals Seidman Cancer Center, Cleveland, Ohio;6. Thoracic Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio;7. Head and Neck Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Associate Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio;8. Pediatric Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio;9. CNS Section Leader, and Vice Chair of Laboratory Research, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Assistant Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio;10. Professor, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Associate Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio;1. Rush University Cancer Center, Chicago, Illinois;2. Division of Hematology, Oncology and Stem Cell Transplant, Department of Medicine, Rush University Medical Center, Chicago, Illinois;3. Division of Surgical Oncology, Department of Surgery, Rush University Medical Center, Chicago, Illinois;4. Department of Radiology, Rush University Medical Center, Chicago, Illinois;1. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland;2. Department of Radiology, Université Paris Cité, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France;3. Director, Diagnostic Imaging, Johns Hopkins Hospital, Baltimore, Maryland;1. Chair, Department of Radiology, Director, Lung Cancer Screening Program, and Director, Incidental Lung Nodule Program & Lung Nodule Registry, National Jewish Health, Denver, Colorado;2. Vice Chair, Clinical Affairs, University of Maryland School of Medicine, Baltimore, Maryland;3. Chair, Department of Medicine and Director, Multidisciplinary Thoracic Oncology and Lung Cancer Screening Program, Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, Massachusetts; and Harvard Medical School, Boston, Massachusetts;4. Director, Lung Cancer Screening Physician, Director, Virtual Health Director, Primary Care East Department, Lead Provider, Ft. Mitchell St. Elizabeth Primary Care, Physician Director, Policy and Government Relations, St Elizabeth Healthcare, Edgewood, Kentucky;5. Chief, Thoracic Imaging and Vice Chair, Quality and Safety, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;6. Director, Lung Cancer Screening Program, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina;7. Director, Thoracic Imaging Section and Director, Thoracic Imaging Fellowship Program, Early Detection Lung Screening Program, VCU Health Systems, Richmond, Virginia;8. Department of Radiology, University of Illinois at Chicago, Chicago, Illinois;9. Deputy Chair Ad Interim, Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, Texas;10. Associate Chief Clinical Officer for Diagnostics and Clinical Information Management, University of Michigan Medical School, Ann Arbor, Michigan |
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| Abstract: | PurposeRecent price transparency initiatives have considerable limitations, notably due to the complexity of health care products. A single care encounter often consists of several services that may be performed by numerous clinicians and health care facilities that bill independently. The objective of this study was to describe the complexity in billing for nonemergency, noninvasive outpatient imaging and its variation across care delivery settings and imaging modalities.MethodsUsing billing records from the 2019 IBM MarketScan Commercial Database, the authors examined the number of billing entities involved in outpatient imaging encounters and the sets of relevant items and services for which patients were billed.ResultsIn total, 5,210,129 imaging encounters were analyzed. Patients received bills from multiple billing entities for 70.9% of hospital-based encounters, 4.5% of office-based encounters, and 7.6% of encounters at imaging centers. Contrast agent was billed separately from the imaging procedures in 55.9%, 71.5%, and 55.3% of encounters for contrast imaging at hospitals, offices, and imaging centers, respectively. Billing for other ancillary items and services (facility fees, 3-D reconstruction, anesthesia and sedation) was relatively rare.ConclusionsTwo key aspects of billing complexity may make obtaining complete and reliable price estimates before receiving outpatient imaging difficult for patients: the number of billing entities involved in care delivery and billing for fees and ancillary services beyond the primary imaging procedure. Given that price transparency initiatives are aimed primarily at helping patients anticipate the total cost of their care, policymakers, payers, and providers should take additional steps to provide patients with reliable information on the prices of entire care experiences. |
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| Keywords: | Medical billing outpatient imaging complexity price transparency |
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