Reasons the charges of hospitals and providers have increased

Updated on February 14, 2023


  • Hospital billing is a difficult and complex process. Insurance companies, hospitals, doctors and the certain federal government have created certain tasks for patients to navigate. However, hospital billing services and procedures tend to follow a set of rules which brings clarity to the situation.
  • The practice that stands out in terms of hospital billing is overcharging with the ability to negotiate the total costs. High rates are consistently charged by the medical staff, such as doctors, for certain practices with the ability to negotiate with respective insurance companies. 

However, we go deep into the topic to observe the reasoning behind this occurrence, the procedure of occurrence and how can we adapt to it.


1. Registration

  • The moment a patient schedules an appointment, he is claiming to be pre-registering with his respective doctor. If he has seen that particular doctor for the first time, he will be told to provide the hospital billing specialists with personal and insurance details.

2. Creating a financial responsibility

  • In this part, the amounts that owed for the visit are determined. As this process goes through, it will also help in determining the hospital billing services that are monitored under the insurance plan. The patient has to remember that insurance coverage has the ability to deviate which means his hospital billing services or respective medical details may not be analyzed.

3. Check in and Check out

While the procedure of check in is taking place, the patient provides his comprehensive personal and insurance details to the front end. However, during the procedure of check out, patient’s medical report will be generated and then delivered to a certain medical coder. After this, the report gets translated into an actual medical code. As a result, super bill is generated that is delivered to the hospital biller. The biller is an integral part of the hospital billing company like Medcare MSO, the hospital billing services, where the bills are prioritized to the fullest.

4. Coding and Billing compliance 

  • When the claims are established, they tend to follow some principles such as the inclusion of patient’s information alongside the processes that are implemented. Hospital billing specialists have the responsibility to meet the desired standards of hospital billing when the bills are delivered.

5. Submission of claims

  • The submissions of those particular claims are done depending upon the billers’ requirements.

6. Adjudication 

  • Analyzing payer adjudication, responsibility of the insurance company, involves a payer evaluating a medical claim and determining whether it is a complaint or not. A certain claim can be accepted, denied or rejected.

7. Patient bills

  • When the adjudication process is completed, the statement is then sent to the patient. In a few aspects, an assurance of advantages will also be sent to the respective patient.

8. Patient payments

  • As soon as the procedure of patient bills regarding hospital billing is completed and the bill is delivered, the patient determines whether to pay any remainder that insurance company may not have. If there is any negligence in the bill, it will be dispatched to a collections agency for further processes.

Common processes and procedures

When all the details mentioned above breaks down the procedure of hospital billing, the costs in correspondence to the patient’s bills and coverage can draw a comparison.

If we look at the providers, they assign costs to patients depending on the charges applied instead of the costs of providing care. However, the final bill is not affected by factors such as the profile used, equipment and medical details.

If we look at the negotiations with insurance companies regarding the final cost, the factors that can be used are listed below.

1. Supply and demand

Just like the cases of many other medical services, specialists often use demand for their hospital billing services to determine the respective prices. If the demand is high, it usually leads to a higher medical bill.

2. Hospital’s capacity

If there are more beds provided in a certain hospital, it will be able to provide more hospital billing services. This will result in a reduction of prices when it comes to hospitals that are around. The reason being their ability to offer better coverage than their respective competition.

3. Hospital’s reputation

If there is are hospitals having a remarkable reputation, various awards and recognition, they often charge far more for their hospital billing services in comparison to other hospitals.

4. Description master

It is a referred to as a major resource list that billing specialists use to finalize the cost of a hospital billing service at a certain hospital.

The decisions regarding costs of hospital billing services and procedures are already taken by the hospitals and providers due to a blend created by the factors above. These factors also identify that insurance companies are essential in the coverage of certain procedures, which indicates they can charge according to their will and still get paid. 

Reasons behind overpaying of bills by doctors

If we become more precise, there is an overpaying of bills by doctors at the beginning of any treatment. The reason being their complete understanding of 2 things. Firstly, insurance companies are open to do negotiations and roughly 25% of all patients do not have insurance. Secondly, the patients will never be able to receive payment for treatment. For example, around 5 years ago, around 67% of hospitals had damaging losses financially providing care to patients and 25% of the wasted money.

Losing money is very damaging to hospitals as well as the doctors. Despite the fact that costs of hospital bills may seem considerably high, the final costs can be comparatively lower. In addition to that, making up for the claims that are unpaid is an internal part of the billing procedure. There is no ideology behind how much any given service costs. It is all in correspondence to the numbers that are being set and achievements made through those earnings. In correspondence to that, we can determine whether to continue existing as a hospital or provider.

Avoid overcharging 

The most appropriate way to avoid overpaying of bills is to do your research efficiently. A resource in Houston, United States works by letting the patient have a complete understanding of what the standard or going rate is for specialized medical processes.

Even though complexities and other factors also enable you to make an informed choice on where to have the completion of your process. There are certain cases where a patient’s company will pay for them to reach the respective hospital at any cost or doctor who fits both the demands of quality and quantity.

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