Becker's Hospital Review

12 CFO / FINANCE 9 ways coronavirus can wreak havoc on patient finances By Alia Paavola C OVID-19 has the potential to jeopardize Americans' physical health and their finan- cial well-being, reported Business Insider. Here are nine ways: 1. While the CDC isn't billing for coronavirus testing, patients will likely be responsible for charges, such as a trip to the emergency room or urgent care. 2. For an out-of-network emergency room visit, pro- cedures related to coronavirus testing and treatment could range from $441 to $1,151, according to Busi- ness Insider. 3. For an outpatient office visit to an out-of-network facility, charges would range from $149 to $327, ac- cording to Business Insider. 4. e average deductible for Americans who get health insurance through their employer is $1,655. However, many workers may not have hit their de- ductibles yet. 5. About 27 million Americans, or 8.5 percent of the U.S. population, don't have health insurance, ac- cording to the report. Of the uninsured, 28 percent said they had difficulty paying off a medical bill in the last year. 6. Americans also may be affected by surprise bill- ing, which occurs when a patient receives care at an in-network facility, but receives a higher bill than expected because a physician who treated them or handled their tests may be out of network. Surprise billing hits 1 in 6 ER or hospital patients. 7. According to Business Insider, if an in-network facility is full and diverts someone to an out-of- network one, a patient could be stuck with a bill exceeding $10,000. 8. More than 25 percent of U.S. adults have delayed getting medical care for financial reasons, according to the report. 9. A Miami resident was charged $3,270 for coro- navirus-related treatment in February. He received a bill that included charges of $1,261 for virus and flu testing and $819 for an ER stay before his copay. With his copay applied, he was stuck with $1,400 in out-of-pocket costs, according to Business Insider.n Mayo Clinic Health System closes hospital March 1 By Ayla Ellison M ayo Clinic Health System closed its hospital in Springfield, Minn., on March 1, but Minneapolis-based Allina Health is stepping in to provide some services to local residents. Rochester, Minn.-based Mayo announced plans in December 2019 to close the hospital and its clinics in Springfield and Lamberton, Minn. At that time, James Hebl, MD, regional vice president of Mayo Clinic Health System, said the facilities faced staffing challenges, dwindling patient volumes and other issues. The hospital in Springfield is one of eight hospitals within a less than 40-mile radius, which has led to declining readmissions and low use of the emergency department, Dr. Hebl said. The two clinics already shut down as well. Allina Health plans to open outpatient clinics in Springfield and Lam- berton at the current Mayo facilities this spring, according to Mayo's website. Allina Health will also provide healthcare services to resi- dents of St. John Lutheran Home in Springfield and Valley View Man- or in Lamberton. After the transition, most of the staff members and clinicians working at the clinics will be from the previous Mayo team, The Journal reported. n Aetna, Optum misused CPT codes to hide administrative charges By Morgan Haefner T he American Medical Association said Aetna and Optum mis- used Current Professional Terminology codes to hide adminis- trative costs, according to a judicial advocacy post. The post concerned an amicus brief the AMA filed in the case Peters v. Aetna. The AMA said the 4th District Court of Appeals in Virginia should overturn a previous judgment that denied the companies' lia- bility in passing administrative charges through CPT codes. According to the AMA, an explanation of benefits to plaintiff Sandra Peters and emails between the companies' employees showed Aet- na used code 97039 to charge Ms. Peters an administrative fee when billing for a chiropractic visit. According to the AMA, a lower court decision ruled: "Optum is the provider of the network, the [explanation of benefits] identifies Optum as the 'provider' for the service and reports a total 'amount billed,' which includes the flat-rate contractual fee to Optum and the CPT code required by the Aetna-Optum contracts. … Under the Aet- na-Optum relationship, Optum receives payments only from Aetna itself, never from an Aetna member or plan sponsor." In calling on the court to overturn the decision, the AMA said the defendants didn't legitimately choose a CPT code, they aren't a pro- vider like a physician or hospital, and as an Aetna member, Ms. Peters was asked to pay the administrative charge. n

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