On Fridays, we schedule our rounds with Healthcare Brew readers. Want to be featured in an upcoming edition? Click here to introduce yourself.
This week’s Making Rounds spotlights Jenni Nolan, a board-certified patient advocate and owner of Clear Healthcare Advocacy, which helps patients understand their medical bills and insurance claims to look for and resolve possible errors. She works with billing offices on the behalf of her clients to potentially reduce their balance and set up payment plans.
Nolan, who is based in Carmel, Indiana, spoke about her journey into patient billing advocacy and the tools she uses to help negotiate client medical bills.
This interview has been lightly edited for length and clarity.
How did you get involved in patient billing advocacy?
As a profession, it is relatively new. I’m a board-certified patient advocate, and the board certification just came about in 2018. I got certified in 2019. An independent patient advocate like myself, we are looking out for the patient—we’re hired by the patient.
I became obsessed with medical billing when I worked as a physician office manager for an OB practice. I would research every claim that we sent out the door. There were so many errors that I just became obsessed with the whole thing. Then I started noticing here at home—I’ve got me and my husband and four kids—and they say that anywhere between 30%–80% of medical bills are incorrect—I can guarantee you that at least 30% of the ones that come into my home are not correct. So I just started thinking, “This is horrible, and what do people do who don’t understand it?” I started researching “patient advocate.” And I was thinking, “This is an actual thing—I can do this, and people will actually pay me to do it.”
What healthcare trend are you most optimistic about and why?
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There’s just so many things going on in the system that help push the price of healthcare up, and I’m starting to see the government and our legislators take notice and start to work to bring things back under control.
I actually spoke at the Indiana House of Representatives last month in support of House Bill 1004, aimed at lowering the cost of healthcare. And several states have the same legislation slated or already enacted.
Tell us one new or old health tech product or platform that’s made your life easier, and why.
Sage Transparency—it was put out by the Indiana Employers’ Forum last May and that is where I can go when I’m negotiating prices. You can pull up hospitals by state, by organization. It will tell you how much that hospital needs to charge on average to break even as a percentage of Medicare, which is a guideline that we use in the healthcare industry for pricing. It’ll say OK, to break even I need to charge 2x Medicare. It also shows me the percentage that they’re actually charging and it’s way more than when they need to break even usually. That’s when I’m able to use that tool and reach out and say, “Look, my client has a bill that’s $X and I can see that you’re charging five times Medicare. Why don’t we take this bill down a notch to where it’s twice the price of Medicare or I’ll even give you a little profit, let’s make it three times Medicare, right?”
You can use Sage Transparency to look at that and negotiate those numbers and those numbers that are on there are from reports that the hospitals themselves are required to submit to CMS each year.