Practices are dealing with increasing numbers of patients with high-deductible health plans, requiring them to collect larger patient balances from patients — some of whom are likely struggling to pay for healthcare. Jeff Wood, vice president of product management for Duluth, Ga.-based, revenue cycle management company Navicure, says this change has been a jolt to many practices.
"What we've seen in the last decade or so is a real shift from the payer side in terms of reimbursement to the patient side … You could count on a practice seeing about 10 percent to 15 percent of revenue coming from individual patients, now over 30 percent or almost a third of revenue is coming from individual patients," he notes.
This sea change means practices must reexamine their billing and collection processes and even reconsider basic practice policies, such as when to send a patient account to an external collection agency for nonpayment. It also means the triangulation between the physician, the insurance company, and the patient has taken on a new dynamic. No longer can practices expect their revenue stream to flow largely through payers. They must give patient collections equal attention.
A NEW ANIMAL
The healthcare insurance exchanges created by the Affordable Care Act are now in their third year. Despite an initially slow rollout, 12.7 million Americans have purchased health insurance through the federal or state healthcare exchanges as of Feb. 1, 2016, according to data released by CMS. For some patients, this is the first time that they have ever had health insurance coverage; so terms like deductibles, copays, and coinsurance are essentially meaningless. That puts the burden for patient education on already overwhelmed practice staff. And consider for example, a Bronze plan (which typically carries the lowest premiums, yet highest out-of-pocket costs) purchased through the healthcare exchange could come with an annual deductible of more than $6,500 for a single individual. That could be a princely sum for low- or middle-income patients, and sometimes it's completely unexpected.
Mary Pat Whaley, president of consulting firm Manage My Practice, based in Durham, N.C., calls high-deductible plans "first dollar plans, because the first dollar that you spend after Jan. 1 applies to the deductible," she says. "So people getting medications in some cases, people going in for the flu to primary-care doctors, who never had any of those types of things apply to their deductibles, suddenly do."
A scenario like this, handled awkwardly, could mean angry patients and stressed-out practice staff. So how can your practice approach these delicate negotiations, while preserving the doctor-patient relationship and ensuring that practice revenue flow is not negatively affected? Practice management experts advise practices to establish clear policies that govern how both patients and staff will approach the collection and payment of patient financial responsibilities, like copays and deductibles.