UNM’s Center for Social Policy releases scathing report on New Mexico's billing burdens
Following last month's presentation to the Legislative Health and Human Services Committee, University of New Mexico’s Center for Social Policy has just released the final findings of focus group interviews with New Mexico health professionals and claims processors. The report, authored by Dr. Melanie Sonntag and Dr. Gabriel Sanchez, describes their frustrations with the complex and time-consuming billing and claims processing system in New Mexico’s hospital and private medical practices.
Click here to watch the presentation, which begins the video. Fast forward to 11:22 AM to hear our Executive Director Mary Feldblum’s comments.
What's in the Report
While there have been many general studies describing the cost and complexity of health payment systems in the United States, this is the first time that a state has collected detailed information from those who experience it first-hand.
Click here to read the full report.
In the executive summary the authors write: “Our findings showed that the medical billing revenue cycle, which is the process that manages all financial aspects of patient care, is highly complex and time intensive, which has adverse impacts on patient care and clinician well-being.”
The report points out that systemic solutions are required to address the problems created by this complex private and public insurance payment system. These include: frequent changes to claims processing requirements, prior authorization constraints that delay needed care, claims denials that impact revenues, payments only made to in-network providers. These and other systemic problems have especially harmful effects on those who live and work in rural areas.
What's Next
Committee Chair Liz Thompson emphasized the importance of continuing this research. This upcoming legislative session, LHHSC will be requesting that the Legislative Finance Committee include funding in the proposed state budget so the work of this critical cost drivers project can continue.
While the UNM report makes a clear case that medical claims and billing are costly both financially and psychologically, specific reforms are outside of its scope. Stay tuned for details on how Dr. Miriam Laugesen of Columbia University’s Mailman School of Public Health will pick up the thread of how to reduce administrative burden in New Mexico’s healthcare system.