How to Handle High Profile Billing Issues

Important advice when dealing the media.

Because the federal government and health insurers are covering the cost of the COVID-19 vaccine and its administration, it is generally inappropriate for healthcare organizations to bill a patient receiving a vaccine. But mistakes happen. 

A client of mine recently called in a panic, as they discovered they had inadvertently billed a number of patients for their vaccinations. Their experience offers some lessons. First, when it comes to big, high-profile billing issues, the types of things that might get you on TV, it can be worth taking the time to provide broad education to everyone in the billing department.  

Choosing when to send a notice is challenging. There are innumerable billing issues, and if you are emphasizing everything, functionally, you aren’t emphasizing anything. But I do not think that anyone was terribly surprised that this particular error wound up garnering media coverage. Generally speaking, you are not going to be on TV for billing with the wrong site of service. But making a mistake on a national health priority is the sort of thing that generates news stories above the fold and teaser previews on television. When a mistake is likely to be high-profile, it can be worth a department-wide note to make sure everyone knows the rule.

Second, put real effort into training everyone who might interact directly with patients on strategies for ensuring that any patient who calls with a question about their bill both is, and feels, listened to. It is somewhat common for anyone, including customer service professionals, to get too committed to defending a position. When the first patients called with questions about the vaccine, they received pushback from the billing office. The patients had identified a problem, but their concerns were dismissed or minimized. Even when staff recognized an error, they assumed it was unique, and failed to encourage a broader review of other patients. Since the callers generally knew that they were right and the person they were speaking to was wrong, getting the pushback was extremely inflammatory. It is bad enough to get a bill that you know you aren’t supposed to receive, but then when the person you call to correct it chooses to argue with you, that can trigger the desire to call the local news station. 

Which brings me to my final point. Whether you are talking to the patient or the local TV station or newspaper, what should you say? Many lawyers recommend avoiding all comments to the media, or offering a curt “no comment.” I strongly disagree with that strategy. In a situation where you know you’ve made a mistake, an apology is usually a wise strategy. Whether you are dealing with a frustrated patient or a concerned regulator, there is a very real possibility that that person’s main goal is to get a sense that you recognize the problem and are going to fix it.

While there are certainly some people who will want to exploit the error for financial gain, it is far more common to encounter someone who just wants to be treated with respect. An apology will often defuse what is otherwise an explosive situation. I am not suggesting talking with the media is risk-free, and you certainly want to avoid a situation in which you present something as factual unless you are 100 percent certain it is correct.

If you have insurance that may cover any liability, it may be worth confirming that the insurer won’t try to deny coverage because you have apologized. But in most situations, a well-crafted apology is a sound risk management strategy. 

Programming Note: Listen to David Glaser’s “Risky Business” reports every Monday on Monitor Mondays, 10 Eastern.

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David M. Glaser, Esq.

David M. Glaser is a shareholder in Fredrikson & Byron's Health Law Group. David assists clinics, hospitals, and other health care entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David's goal is to explain the government's enforcement position, and to analyze whether this position is supported by the law or represents government overreaching. David is a member of the RACmonitor editorial board and is a popular guest on Monitor Mondays.

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