NATIONAL HARBOR, Md. — At this week’s annual meeting of hospital finance leaders, the exhibit hall was packed with dozens of billing and collections companies. Armed with candy, tote bags, and pens, they smiled at passersby, eager to explain why their tactics would extract the most money from health insurers. 

The sheer number of “revenue cycle” vendors who attended the Healthcare Financial Management Association’s annual conference in Maryland — outnumbering even the hospital attendees, according to a list shared by an organizer — was a visible reminder of the enormous industry built around just paying medical bills. 

The U.S. health care industry spends roughly $200 billion annually on financial transactions: claims processing, payment, collections, and prior authorization. And yet the proliferation of billing vendors seemed to clash with the main theme of HFMA’s conference, affordability, spotlighting the need to simplify the billing process so that health care is less costly and more accessible for patients. 

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