Methodology: Best Hospitals for Billing Ethics


The Leapfrog Group is a non-profit organization dedicated to helping consumers make informed decisions about their health and access safe, high-value care. For more than two decades, it has collected and published data on patient safety and quality of care from voluntary surveys and other sources. More than 2,200 hospitals responded to its flagship Leapfrog Hospital Survey in 2022.

To compile his new list of best hospitals for ethical billing practices in partnership with Money, Leapfrog Group used data submitted through the Leapfrog Hospital Survey 2022, which participants were required to submit by August 31, 2022. These categories are Inpatient Care Management, Complex Adult Surgeries and Pediatrics, Pediatric Care, Medication Safety, Maternity Care, Ambulatory Procedures and Infections.

To qualify for the list, eligible hospitals had to have an A or B rating in the Leapfrog Hospital Safety Rating Assessment for Fall 2022. Hospitals also had to meet a qualitative excellence assessment and were disqualified if they exceeded national death rates. for heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, or coronary artery bypass surgery or if they scored a C or worse in the Spring 2022 safety grade assessment.

Leapfrog applied additional criteria related to safe medication ordering practices (to avoid medication errors), intensive care unit staffing, response to “never events” (medical errors if that should never happen to patients, such as operating on the wrong part of the body or a transfusion of the wrong type of blood), and performance related to certain high-risk surgeries, including heart surgeries, bariatric surgery, hip replacements and lung cancer surgeries.

The group also assessed criteria specific to pediatric hospitals, including safety and management procedures related to keeping radiation exposure during CT scans at levels safe for children and assessments related to the overall experience of care for children and their families. Certain criteria for safe drug prescribing, high-risk procedures, and qualitative assessment of excellence have not been applied to pediatric hospitals.

The 565 hospitals that made the cut are a combination of hospitals for adults and children, urban and rural, teaching and non-teaching, etc.

For more information on Leapfrog’s standards, visit Leapfrog’s hospital survey measurement page.

For the full methodology, read below.

For the list of best hospitals for ethical billing practices, the following criteria were applied:

I. Early Elective Issues Billing Ethics: A hospital must adhere to the Leapfrog Standard for Billing Ethics

The quality of billing is the quality of health care. Hospitals should strive to ensure that their patient billing process meets the highest ethical standards. This measure assesses whether hospitals have taken the following steps to ensure ethical billing:

1. Hospital provides each patient with an itemized billing statement and/or master invoice within 30 days of final claims adjudication that includes all of the following:

  • Name and address of the establishment where the services billed took place

b. Date(s) of service

vs. An individual item for each service or group of services performed

D. Description of billed services that accompanies each line item or set of services

e. Amount of any principal, interest or charges (e.g. late or processing fees), if any

F. Amount of any bill adjustments (e.g., health plan payment or discounts), if applicable

g. Amount of payments already received (from the patient or any other party), if any

h. Instructions for applying for financial assistance

I. Instructions on how to obtain a copy of the invoice in the patient’s primary language

J. Notice that medical services will be billed separately, if applicable

2. The hospital instructs patients to contact a billing representative who has the authority to investigate errors on a bill, review, negotiate, and offer a price adjustment or discount. debt according to hospital policy and establish a payment plan, within 5 working days

3. The hospital does not take legal action against patients for late or insufficient payment of a medical bill

To meet Leapfrog’s standard, the hospital must perform the above three operations. For more information see:

High medical prices and billing practices can reduce public confidence in the medical profession and can lead to avoidance of care. In a survey of 1,000 patients, 64% said they had delayed or neglected seeking treatment in the past year due to concerns about high medical bills.[1]

II. Hospitals eligible for a Leapfrog Hospital Safety Rating must receive an A or B on the publicly announced letter grades at the time of the public announcement of top hospitals for ethical billing practices.

Note: This criteria does not apply to hospitals that are not eligible for a security rating, such as military treatment facilities, specialty facilities, critical access hospitals, etc.

The Leapfrog Hospital Safety Grade rates hospital safety for patients. Each A, B, C, D or F score comes from an expert analysis of publicly available data that consumers can use to protect their family from harm or death during a hospital stay. Some hospitals are exempt from receiving a safety rating, including specialty hospitals like children’s or surgical hospitals and critical access hospitals. Rating-eligible hospitals, including general acute care hospitals, must receive an A or B on the current Leapfrog Hospital Safety Rating (Fall 2022) in order to qualify for the list of Top Hospitals for Billing Practices ethics.

[1] Heath S. 64% of patients avoid care due to high patient healthcare costs. HIT Patient Engagement website. Published February 2018. Accessed November 1, 2019.

[KBS1]I didn’t use change tracking for the updated criteria below. Everything has been edited.


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