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De-Coding the Medical Bill

May 12, 2011

This article is re-posted from User Centric’s blog.

How to improve patient satisfaction and billing efficiency with a little user research

It’s an all too familiar situation: a month after your routine check-up, you receive a medical statement from your physician’s practice. As you’re looking over the document, you become frustrated and confused, often with multiple, simultaneous questions running through your mind: how much did my insurance cover? How much do I owe? Where can I find information to cross reference both the medical statement and my insurance coverage to make sure I’m not being over charged?

After my own perplexing incident with a medical statement, I now see an increasing need for a user-centered approach to medical billing. While there are no conclusive data on medical billing errors, it’s well known that these statements are not easy to read. What’s worse is that while billing errors are often correctable, fighting those errors takes some serious elbow grease and to some patients, the task of challenging a difficult-to-read statement seems unrewarding.

User-centered design: Improve the design to increase visibility of existing items and reduce patient frustration

As a UX professional, I know that the way in which information is provided to a user is of utmost importance to the overall experience. Poorly designed medical bills can cause an increase in calls to both the healthcare provider and the insurer, lead to incorrect data input, an increase in processing times for payments and claims, a negative impression on the process, and overall patient frustration. However, simple improvements will lead to an increased payment turnaround rate, reduced need for assistance, higher accuracy of data input, and a more satisfying patient experience.

In my own experience, the most frustrating design aspect of a medical bill is the lack of a line-by-line breakdown of information. The medical assessment, the amount owed, the insurance coverage, and the end balance are almost always on the bill itself, but never clearly recognizable.  While I often say “I just want to know what I owe,” I am still interested in understanding how that number came to be. This is when user-centered design is vital.  A successful design process would identify user’s needs and how they interpret information.  Then build the information architecture so the bill is clearly understood by the patient.

Based on my years of user-centered design research, one simple suggestion would be to include all of the pricing in the same column, so that the “balance due” clearly adds up, line by line. From my experience, users recognize procedures by the appointment date and the physician, rather than the procedure. To keep things simple, descriptions of services performed on the same day should be associated with the date of the appointment, the physician’s name, insurance coverage and total cost. If a patient visits multiple doctors, the statement should indicate which doctor and what procedure correlate to what charge.

I propose a more strategic organization of the ‘look and feel’ of the bill itself, especially because the overall design of a document can have tremendous impact on user frustration. Designers should consider a landscape layout instead of a portrait layout to expand columns and increase space for helpful details. One particular tool in a designer’s toolbox to keep in mind is white space: using white space to separate each item will create a more legible document. My recommendations are twofold: in order for a more harmonious bill, medical statements should synchronize commonalities of items and group those items together; white space should be used to gently separate each group on the statement.

At the very least, information should be presented without medical and insurance jargon

If you’re anything like me, you also feel constrained by the terminology and the language used on the medical statement. Non-technical language should be used whenever possible because users are frequently confused by terminology they do not understand. As a patient, I need to be able to recognize medical items on the statement (e.g. assessment, medication, procedure. test result) in order to understand the balance owed. Ideally, the items on the bill should help bridge the gap between layman’s knowledge and medical terminology by helping patients translate their own understanding into defined medical terminology. By using familiar terminology, users have a much clearer idea of which medical costs they are being asked to cover, also ensuring the accuracy medical statements.

User-centered testing is necessary to achieve comprehensible medical bill design

In general, the best way to ensure simple and informative readability of medical bills is through user research of all parties: patients, healthcare providers, and insurers. Even a handful of observations in all workplace environments, including observing multiple party interactions can improve the overall experience of medical billing. Here are three important usability questions to identify major issues with medical bills and make suggestions for improvement:

User effectiveness — Can the user respond to the statement without making errors?

User efficiency — Can the user understand what specifically requires action in a timely manner?

User satisfaction– Is reading the medical statement a neutral to pleasant experience?

Identifying areas of confusion and understanding user interpretation of a medical bill will not only benefit the patient, but also greatly increase the efficiency when processing insurance claims and collecting medical payments.  The user is satisfied, the insurance companies receive fewer phone calls and the hospitals get paid, it’s a win win win.

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