Best Practices for Resolving Medical Billing Disputes: An Overview of the HFMA Report


Billing disputes are never fun, but by adopting a fair and consistent approach, medical providers can resolve them in a way that is satisfactory for all parties.


The proper resolution of bills related to medical services presents many challenges for both patients and healthcare providers. To help with those challenges, the Healthcare Financial Management Association (HFMA) has partnered with the Association of Credit and Collection Professionals (ACA) to release the publication “Best Practices for Resolution of Medical Accounts.” This release is an update of the 2014 report and is partially in response to billing challenges related to COVID-19. The report is available for download at hfma.org/dollars.

Best practices report overview

The primary audiences for the HFMA’s “Best Practices for Resolution of Medical Accounts” report are healthcare providers, credit bureaus, and business affiliates (e.g., organizations that contract with healthcare providers to work directly with patients to resolve outstanding medical accounts). The secondary audience is patients and policy makers.

The goals of the best practices report are consistency and standardization of billing problem resolution. Most patients want to resolve medical billing issues fairly and responsibly, but the process is confusing because of a lack of standardization of billing practices. The report helps provide a clearer understanding of what to expect at every stage in the billing process. It also makes it clear that providers are responsible for educating patients about their estimated responsibility, the existing payment options, the availability of financial assistance programs, and the overall account resolution process.

Key takeaways of the best practices report

The HFMA’s best practices report provides important direction for resolving medical accounts. Here are some of the report’s key points:

  • After receiving third-party payment, efforts turn to patient balance. But before contacting the patient, ensure the balance is correct.
  • Use patient-friendly billing: clear, concise, and correct.
  • Providers should make reasonable efforts for account resolution — letters, phone calls, bankruptcy, payment plans, financial assistance help — before labelling an account delinquent.
  • Extraordinary collection actions (ECAs) should be pursued only after reasonable efforts to resolve a patient’s account have occurred.
  • The initial patient billing date is the start date to be used for all resolution efforts (e.g., reporting to a credit agency shouldn’t happen until 120 days after the initial billing date).
  • All resolution efforts should follow the provider’s standard resolution policies, agreed upon by all stakeholders.
  • Assignment of an account to a business affiliate does not imply delinquency of the account. Also, ensure multiple entities are not pursuing payment; only one agency should be contacting the patient.
  • Providers should have written, board-approved policies about the disposition of unresolved accounts (e.g., placing the debt with a secondary business affiliate, selling the debt to a certified debt buyer, or discontinuing efforts and writing the account off).
  • Patient complaints should be tracked and shared between the business affiliate and the provider to improve customer service, assist with account resolution, and avoid reoccurring complaints.
  • Self-payments due to rising insurance costs and deductibles are becoming increasingly common. It’s important to have written policies, consistent practices, and flexible payment options that reflect patient preferences.

The biggest challenge to a positive patient financial experience is the complexity of medical bills. To help overcome this obstacle, the best practices report emphasizes the importance of educating patients about billing and the account resolution process.

Need help managing your revenue cycle? Contact TruBridge today.

Written by Megan Smith
TruBridge Director of Quality and Training

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