In a recent government meeting, Stephanie Wells, System Vice President of Revenue Cycle at Ochsner Health, provided insights into the hospital's billing practices, particularly concerning third-party liability cases stemming from motor vehicle accidents. With 28 years of experience in healthcare administration and public accounting, Wells outlined a structured approach to billing that categorizes patients into three groups: commercially insured, Medicare/Medicaid, and uninsured.

For commercially insured patients, Ochsner Health bills the insurance company directly, accepting only the amount that the insurer would typically reimburse. In cases where the insurance denies the claim, the hospital will negotiate with the third party but will not accept more than the insurance payment rate.

When dealing with Medicare and Medicaid patients, Wells explained that the hospital collaborates with patients to gather necessary third-party information. Payments are capped at the Medicare and Medicaid fee schedules, and if payment is delayed, the hospital will bill Medicare or Medicaid as a conditional payment.

Uninsured patients benefit from a self-pay discount, which is calculated based on IRS regulations. This discount ensures that uninsured patients pay no more than what insured patients would have paid for similar services in the past year. Wells emphasized that regardless of third-party liability, the hospital will not charge uninsured patients more than the discounted rate.

Wells also addressed scenarios where patients might decline to use their insurance. In such cases, Ochsner Health will still bill the insurance provider if coverage is identified, ensuring that the patient is charged no more than what their insurance would cover.

The meeting also touched on the hospital's compliance with federal laws requiring transparency in pricing. Wells confirmed that hospitals must post their charges online, and staff are available to assist patients in understanding their bills.

Overall, the discussion highlighted Ochsner Health's commitment to fair billing practices and patient support, ensuring that all patients, regardless of their insurance status, receive equitable treatment in billing for medical services.