Complex Billing for Nonemergency Outpatient Imaging: An Obstacle to the Success of Health Care Price Transparency Initiatives.

PURPOSE

Recent price transparency initiatives have considerable limitations, notably due to the complexity of health care products. A single care encounter often consists of several services that may be performed by numerous clinicians and health care facilities that bill independently. The objective of this study was to describe the complexity in billing for nonemergency, noninvasive outpatient imaging and its variation across care delivery settings and imaging modalities.

METHODS

Using billing records from the 2019 IBM MarketScan Commercial Database, the authors examined the number of billing entities involved in outpatient imaging encounters and the sets of relevant items and services for which patients were billed.

RESULTS

In total, 5,210,129 imaging encounters were analyzed. Patients received bills from multiple billing entities for 70.9% of hospital-based encounters, 4.5% of office-based encounters, and 7.6% of encounters at imaging centers. Contrast agent was billed separately from the imaging procedures in 55.9%, 71.5%, and 55.3% of encounters for contrast imaging at hospitals, offices, and imaging centers, respectively. Billing for other ancillary items and services (facility fees, 3-D reconstruction, anesthesia and sedation) was relatively rare.

CONCLUSIONS

Two key aspects of billing complexity may make obtaining complete and reliable price estimates before receiving outpatient imaging difficult for patients: the number of billing entities involved in care delivery and billing for fees and ancillary services beyond the primary imaging procedure. Given that price transparency initiatives are aimed primarily at helping patients anticipate the total cost of their care, policymakers, payers, and providers should take additional steps to provide patients with reliable information on the prices of entire care experiences.