Becker's Hospital Review

16 CFO / FINANCE New York hospital reviews billing practices after patients mistakenly charged for ED COVID-19 testing By Alia Paavola A New York hospital said it would re- view its billing practices aer several patients complained about receiving bills above $1,000 for COVID-19 tests in its emergency department. Patients of St. Francis Hospital & Heart Cen- ter in Roslyn, N.Y., told ABC 7 in March they were blindsided by the bills. Lisa Mar- schall said she was faced with a $1,800 bill for COVID-19 testing, and another patient said she was charged nearly $10,000 for four COVID-19 tests aer visiting St. Francis Hospital's ED. e costs of the COVID-19 tests are just $100, according to the hospital's website, but patients were also charged an emergency room fee of $1,545. is ER fee is not disclosed on the hos- pital's website about COVID-19 testing. Charles Lucore, MD, president of St. Francis Hospital, told Becker's Hospital Review that the hospital is obligated from a quality, safe- ty, regulatory and liability perspective to pro- vide complete medical evaluations to patients who come to the ED for any service, including COVID-19-related services and testing. As a result, the hospital charged the patients for a level 3 ED visit. Under current law, providers can submit claims to insurers for COVID-19-related services and testing, but insurers are not supposed to pass along these costs to patients. Section 6001 of the Families First Act, which was amended by the Coronavirus Aid, Relief and Economic Security Act, requires private health plans to cover COVID-19 testing and the administration of that testing without member cost-sharing. e coverage also ex- tends to services provided during a medi- cal visit that results in COVID-19 testing or screening. ese coverage protections are in effect until the public health emergency ends. Despite these protections that should have prevented any out-of-pocket costs from being passed on to the patients, St. Francis patients still received bills for the services. Dr. Lucore told Becker's that he immediately launched an investigation into the billing er- rors aer learning about them and found that some of the bills resulted from insurers mis- takenly applying charges related to COVID-19 testing and COVID-19-related services to pa- tients' deductibles. Dr. Lucore said that the hospital is working with the insurers to get the charges to patients retracted and covered. "We have and continue to contact any patient who [may] have inadvertently been billed and [are] working with their payers to resolve the issue," Dr. Lucore told Becker's. "Cigna, for example, has already rectified their error in assigning responsibility to the patient and has cleared the charges." Dr. Lucore added that patients are not re- sponsible for any out-of-pocket expenses for these services. "We're not going to collect anything for pan- demic-related services," Dr. Lucore said. "at is not our intent." Dr. Lucore added that patients who re- ceived bills for COVID-19 testing were not pressed to make payments nor were they sent to collections. Dr. Lucore said that the billing issue re- vealed that in addition to updating clinical services to respond to the pandemic, billing practices related to COVID-19 services need to be updated. "It was a good lesson for us," he said. St. Francis said it will review its billing prac- tices to avoid any future confusion and plans to increase communication to pa- tients about COVID-19 billing. e hospi- tal has already updated its website to state that there is no cost for COVID-19 testing. It also plans to post signs in the ED and on patient statements that indicate they are not on the hook for COVID-19-related charges, Dr. Lucore said. e hospital's modified website reads: "Pa- tients should not be responsible for any out- of-pocket expenses for these services. If how- ever, a billing issue arises, we are committed to investigate the charges and will attempt to rectify the issue with the insurance carrier. We encourage patients to contact us if they have questions concerning their billing, and we will work with them and their insurers in an effort to resolve any issue." n Mass General Brigham's plan for outpatient clinic gets pushback from safety-net system By Alia Paavola U Mass Memorial Health Care, a safety-net system in Worcester, Mass., is opposing Boston-based Mass General Brigham's plan to build an outpatient center in Westborough, Mass., according to The Community Advocate. Mass General Brigham's outpatient center would offer surgery, primary care, behavioral health, orthopedics, neurology, diagnostic imaging and other spe- cialty care. But UMass Memorial said the center would threaten the sustain- ability of its hospitals and medical school in Worcester. Mass General Brigham's outpatient clinic would cater to those with higher incomes while leaving lower-income patients behind, the safety-net system said. UMass Memorial said that it makes 60 cents to 65 cents per dollar of treatment given to uninsured or underinsured patients, but it makes up the shortfall from patients who have commercial insurance that pays at a higher rate. Mass General Brigham's outpatient clinic could pull away patients with commercial insurance, UMass Memorial said. Mass General Brigham argued that having mental and physical care under one roof would help lower costs and improve access for its 42,000 patients within a 20-mile radius of the proposed site. n

• Cover