Billing Ethics

To help ensure that patients don't delay or avoid necessary care, hospitals should have billing practices in place that adhere to the highest ethical standards. This measure assesses whether hospitals adhere to the following ethical billing practices:    

1. Provides every patient with a billing statement and/or master itemized bill within 30 days of final claims adjudication that includes all of the following elements:
   • Name and address of the facility where billed services occurred
   • Date(s) of service
   • An individual line item for each service or bundle of services performed
   • Description of services billed that accompanies each line item or bundle of services
   • Amount of any principal, interest, or fees (e.g., late or processing fees), if applicable
   • Amount of any adjustments to the bill (e.g., health plan payment or discounts), if applicable
   • Amount of any payments already received (from the patient or any other party), if applicable
   • Instructions on how to apply for financial assistance
   • Instructions in the patient’s preferred language on how to obtain a written translation or oral interpretation of the bill
   • Notification that physician services will be billed separately, if applicable
2. Gives patients instructions for contacting a billing representative who can access an interpretation service to communicate in the patient’s preferred language and has the authority to (a) initiate an investigation into errors on a bill, (b) review, negotiate and offer a price adjustment or debt forgiveness based on facility policy, and (c) establish a payment plan, within 10 business days
3. Does not take legal action against patients for late or insufficient payment of a medical bill

Reporting Period

• 2024

Patients Included in the Measure

• Inpatients (Patients who are admitted to the hospital for at least one overnight stay)
• Outpatients (Patients who are admitted and discharged on the same day)
• Adults and Children