P2 Mobile Logo

Search form


Overcome Exchange Health Plan Payment Challenges

Overcome Exchange Health Plan Payment Challenges

By now, you've been told countless times to get tougher about patient collections. Are you doing it the right way?

This year's King v. Burwell U.S. Supreme Court decision upholding premium subsidies on Affordable Care Act health insurance plans alleviates some concerns about patients as payers, experts say, but high deductibles, larger copays, and mounting system costs are putting significant pressure on patients at a time when they are becoming a larger share of your payer mix.

"With average deductibles between $3,000 and $8,000, you have to change the dynamics of how you interact with patients and be aware that what used to work doesn't anymore," says Chuck Seviour, vice president of revenue cycle consulting with Array Services Group.

If the reform law's premium subsidies had been disallowed in certain states, experts feared system costs would have strained remaining participants even further and millions more would go uninsured. And the more stressed patients become, the less likely physicians are to receive their fees for service.

However, even before the reform law, workplace cost sharing, and the growth of high-deductible plans, internist/pulmonologist Thomas Horiagon regularly dealt with high rates of patient defaults on copays. Today, he operates a time-based, direct care practice, and says patients almost always pay the bill on the spot or within a few days.

"I have a very low overhead model, and everyone understands it is payment at the time of service," he says.


Setting patient expectations is more than half the battle, practice-management consultants say, but there also are a few intangibles to keep in mind.

Chief among them is the value created by support staff members who understand the importance of collections, but also how to deal with patients as customers, says Shep Hyken, a customer service expert and author.

Hiring generally positive people in roles that interact with patients is a given, but spelling out in detail the right words to use in a first encounter is critical in training new staff, he says.

Rather than bluntly asking a patient if her insurance is an exchange plan, for example, make sure that information is already included in her file. Then, the front-desk staffer can begin the conversation with "How would you like to take care of the bill today?" or, "Any changes in your insurance since last time?"

"The doctor's office needs to get paid, but the front-desk person needs to be trained in how to ask the question the right way," Hyken says. "If the questions you ask patients make them feel like second-class citizens, that's a problem."

Hyken once counseled a hospital chain client that was having problems finding nurses with a patient-focused attitude.

"They had made promises to patients and marketed themselves as an organization that was putting patients first, and they knew if they hired the wrong personalities it would erode everything they were working for," he says. "The outcome was they shut down a floor of the hospital for a short period while they waited for the right people. Now, that's extreme, but it showed they were serious about treating patients like people and not a number on an insurance form."


Loading comments...

By clicking Accept, you agree to become a member of the UBM Medica Community.