DECA Financial Services recently read an article regarding the ACA’s attempt to lower the uninusred ranks in America. Please click here for the entire article.
Archive for the ‘Healthcare Providers’ Category
At the beginning of 2014, millions of Americans will be required to obtain health insurance or face a tax penalty. As several recent studies and media articles have demonstrated, those millions known almost nothing about those requirements.
Members of President Obama’s administration have promised in recent weeks that the federal government will publicize the new insurance requirement widely, but as healthcare providers in at least one state have already learned, the real promotion to low-income patients will be done by healthcare providers.
Massachusetts residents have been required to have health insurance for several years. Recently the Healthcare Financial Management Association (HFMA) published a case study of Boston Medical Center (BMC), which revealed it doubled its patient financial services staff temporarily to get as many of its patients signed up for health insurance as possible.
Most healthcare providers do not have the resources to increase staff so suddenly, so one option to consider is reaching out to your partners for additional help.
To read the rest of this post with advice for how to leverage your healthcare debt collection or revenue cycle management partners to assist with these challenges, click here.
Note: This month DECA Financial Sercices, LLC is marking the three year “birthday” of the Patient Protection and Affordable Care Act (ACA) with a guest blog post by the contributing editor of insidePatientFinance.com, Evan Albright. In the article, Evan notes that although we’re three years into the ACA, major portions of the bill–and the ripple effects they will create–have yet to be implemented.
-John Owen, Director of Client Development
Healthcare Reform Turns Three, But Major Impacts Yet to Be Felt
The Patient Protection and Affordable Care Act turned three years old this month and it feels as if we are waiting for the other shoe to drop.
For most Americans, the ACA will provide protections long needed, as previously uninsurable pre-existing conditions no longer prevent them from obtaining coverage, as limits are placed upon deductibles in new health plans, and as health insurance as a whole become much more available.
But while everyone will have access to health insurance, except for those with the lowest incomes, it will not become more affordable. As we pointed out last month, the ACA will reduce the pool of the uninsured but in turn exchange create a larger pool of under-insured.
For providers, having a larger pool of insured patients is a large benefit. But as we have already seen as a result of parents allowed to extend coverage to their young adults children, it offers no guarantee that providers will be paid. As one survey last year found, more than 50 percent of young adults who reported trouble paying medical bills had been covered by insurance.
To read the rest of this article, click here.
The next two years will be rocky for healthcare providers as the number of uninsured and underinsured patients is expected to soar until the full force of the Patient Protection and Affordable Care Act kicks into action.
In 2015 a greater percentage of the population will either be covered by health insurance or will have greater government protection through Medicaid expansion. In the meantime, prepare for a big increase in self-pays and patients with higher deductibles.
These next two years will be bridge years for healthcare reform and stressful to healthcare revenue cycle managers across the country. Here’s what’s ahead for Self-Pays and Uninsured Patients and Underinsured Patients.
For some physicians and hospitals, the new HIPAA Omnibus Regulations provoke a sense of dread at the threat of increased penalties and red tape. But taken in total, these regulations will strengthen the relationship between healthcare providers and their business associates.
The new regulations have been in the works for almost three years were made final last week. There are few surprises amid the 573-page document as many of the regulations were proposed long ago.
One of the most positive aspects to the new regulations is that they clarify and specify the legal relationship between providers and their partners, such as collection agencies, that manage patient information. While the new HIPAA regulations don’t let providers off the hook for transgressions by business associates, they do hold business associates accountable for protecting patient privacy to almost the same standard as providers.
One area in particular where regulatory jurisdiction now will be fully exercised is subcontractors to business associates. The very same protections that must be in agreements that providers are required to have with their business associates must be in place between business associates and subcontractors who comes in contact with patient information.
Providers, fortunately, will not be required to negotiate business associate agreements with their partners’ subcontractors — that is solely the responsibility of the business associate.
One of the most important aspects of a medical practice’s success is collecting the money that a patient owes them. This seems like a “no-brainer,” right? Well that does not necessarily make it an easy feat. Patient out-of-pocket fees account for 30 percent of a practice’s revenue, yet once a patient walks out the door, chances of collecting that money are practically cut in half.
The bright side is that there are ways to improve the collections process in order to ensure payment efficiency. After speaking with practice management consultants, we found four strategies to improve patient fee collection while maintaining strong customer satisfaction.
1. Train Your Team
The office manager may handle claims, but the entire staff should still know insurance policies and procedures. A good way to do this is to train employees on their own benefits. That way they can see it from both perspectives.
Your staff should also be trained on how to ask for money from patients. Requesting payments can be tricky. A good method is to have a script of exactly what to say. For instance, instead of saying “you owe 30 dollars,” a staff member could ask “cash, check or charge?” This less confrontational approach lowers the chances of a patient being turned off.
2. Educate Your Patients
A patient should never be blind-sided by costs. It’s best to be as upfront as possible. This is particularly applicable for patients who have a high deductible or are self-pay. For these patients, try and talk with them before they arrive for their appointment. If your practice offers a discount for patients who pay large amounts on the spot, then discuss this opportunity with them before the time of payment. This makes patients more comfortable about paying a larger amount of the bill.
3. Automate the Collections Process
This is the 21st century. It’s time to accept credit cards. You pay a higher fee for credit card payments, but more patients are willing to pay this way. Ask your patients to keep their credit card information on file. With their permission, you can automate payments of an agreed upon amount.
Starting in January 2013, the Affordable Care Act will require practices to automate patient eligibility too. This should dramatically decrease issues in accounts receivable because patients will know their financial responsibility within 20 seconds.
4. Be Professional About Balances
In the age of information, there should be a record of everything. There should be something in writing for the sake of your practice and your patients. If you decide to accept installments on a balance, have the patient sign a promissory agreement. If you don’t keep it professional, they won’t either.
No matter which of these methods work best for you, be sure to keep the purpose of each one in mind. Communicate your expectations clearly to your staff and patients to make sure there’s an understanding on the how, when and what of out-of-pocket fees.
As the fiscal year for many begins to draw to a close, now is the time to evaluate the effectiveness of your medical debt collection partners.
This should be a once-a-year routine, and DECA Financial Services suggests that you follow the old maxim we learned as children before crossing the street — Stop, Look, and Listen.
Odds are that you are in in the midst of your budget cycle or just finishing it. In the lull between now and the holidays is a perfect time to evaluate your relationship with your collections partner. Any agency worth its salt will expect you to take the stock of your professional relationship at least once a year.
First, analyze the performance of your collection partners over the course of the year. Have they met your expectations? Did you establish those expectations in advance? This is your opportunity to bring your relationship into focus, especially if you have in past years been vague about your demands on your partner.
Now is the time for you to identify and establish the metrics you expect your collections partner to achieve for the next year. The more specific your expectations, the better direction they will have to follow. As the old saw goes, “if you can’t measure it, you can’t manage it.” Most agencies want to know what is expected of them, and by the same token, without strong metrics, those agencies that are less professional will find it easier to take advantage of you.
Don’t go into the next year with a telephone call. This is the time for a face-to-face with your collection partners. Either schedule visits to have them come in to meet with your, or even better, schedule a time for you to visit and tour their facilities. If you haven’t traveled to where they are you will be surprised by how much you learn with a site visit.
If you bring them into your office, be certain to communicate in advance what reporting data you wish them to bring, and what supporting documentation you expect to see. It is also very important to create an agenda well in advance so everyone knows what is expected of them. If you don’t, you may find your partner is unprepared and that will waste everyone’s time.
The truth is you are not meeting with your partner to lay down the law. The most successful relationships between provider and collection agency are those where both parties are careful listeners. Here are some areas where it is vital you keep your ears open:
Are they compliant? Every year there is some change in medical collections regulations or laws. For example, this year the IRS is considering the imposition of a 120-day waiting period before patients who may qualify for charity care can have their debt reported to a collection agency. Is your collection partner aware of the new regulation, and what are their plans to address it?
Are they following scripts? This is a good time to actually listen to your partner’s staff as they make collection calls. Are they following the scripts that you and your partner have agreed upon? Also, are they being properly supervised, with spot checks by supervisors to make certain they are following the course you have set for them?
What do they think will improve the business relationship? Your collection partner will most likely work with numerous providers. If they know their business, they will be able to give you feedback on how best to improve the relationship. The very best providers are those who listen as much as tell. Take advantage of their expertise, and built their feedback into demonstrable metrics for the following year.
Once you have stopped, looked, and listened, proceed with the next year’s work. If you make this an annual occurrence, you should see an increase in your collections and in patient satisfaction, or failing that, the justification to find new collection partners.
2012 Best Places to Work in Collections
Released October 2, 2012
DECA Financial Services, LLC was recently named as one of the Best Places to Work in Collections. This program was created by insideARM.com and Best Companies Group.
This survey and award program was designed to identify, recognize and honor the best places of employment in the collections industry, benefiting the nation’s economy, its workforce and businesses. This year, the Best Places to Work in Collections list is made up of 31 companies divided into three size categories: Small (15-74 employees), Medium (75-249 employees) and Large (250+ employees).
To be considered for participation, companies had to fulfill the following eligibility requirements:
- Be a for-profit or not-for-profit business;
- Be a publicly or privately held business;
- Have a facility in the United States;
- Have at least 15 employees in the United States;
- Must be in business a minimum of 1 year;
- Must be a Collection Agency, Collection Law Firm or Debt Buyer.
Companies from across the U.S. entered the two-part survey process to determine the Best Places to Work in Collections. The first part consisted of evaluating each nominated company’s workplace policies, practices, philosophy, systems and demographics. The second part consisted of an employee survey to measure the employee experience. The combined scores determined the top companies and the final ranking. Best Companies Group managed the overall registration, survey and analysis process and determined the final rankings.
For more information on the Best Places to Work in Collections program, visit
As you know, the medical debt collection is a noisy and crowded market. DECA Financial Services wants to help you maintain your competitive edge in collection recoveries. A strategic partner of DECA, insidepatientfinance has developed online tools, information and best practices to help healthcare finance professionals deliver results and better partner with collection agencies like DECA.
The link below is available for free and provides valuable reports developed by award-winning editors to tackle the key issues the healthcare finance professionals face as they manage the revenue cycle.
The information in these reports and throughout the site will help you increaese cash flow, work more efficiently, and provide better care for your patients.
The U.S. Department of Health and Human Services recently announced that it would test the capitation model of payment reform in Massachusetts. The state’s 110,000 Medicare/Medicaid patients under age 65 will be assigned to an integrated care organization (ICO) in exchange for a set fee per patient that covers all medical treatment for a defined period.
The test will demonstrate if capitation works and is scalable, The Massachusetts test heralds the beginning of a new era of payment reform. But as we all know, payment reform is already here. There is a growing consensus by providers that the well-worn fee-for-service model doesn’t work, and that something has to change. But change is already here, and payment reform, whether we like it or not, has arrived. Unless healthcare providers are proactive, these payment reform trends themselves will literally pick our pockets as payors–be they government agencies or insurance companies–pick hospitals’ pockets.
Federal and state governments already engage in payment reform in its crudest form by simply reducing reimbursements. This trend will continue as the Baby Boomer generation becomes the Medicare generation (or possibly the Medicaid generation considering the millions that have saved nothing for retirement).
In the case of Medicare and Medicaid, there is only one place where the buck stops when it comes to the government, and that is with providers. The winners will be those who become the most proficient and efficient when it comes to seeking reimbursements and avoiding denials. As we mentioned last month, that means getting ahead of the ICD-10 curve. Fortunately the U.S. Department of Health and Human Services has given you another year to get ready.
Health insurers are under tremendous pressure from their customers, i.e., employers, to keep costs down, and so far 2012 has not been a banner year for revenues or profits. Insurers will transfer that financial pressure onto providers, and as UnitedHealth Group recently demonstrated, they will leverage consumers to help them. At the recent HFMA leadership conference, UnitedHealth Senior Vice President Simon Stevens showed off a brief demo of his company’s customer engagement tool that enables their customers, your patients, to see the price and relative quality of procedures of healthcare providers in their area. Stevens called it an “Expedia” of healthcare options.
A recent report by Chilmark Research said that adoption of such tools by insurers has been slow, but is growing. UnitedHealth is the 500-pound gorilla in the marketplace, and where they go, the rest of the pack cannot be far behind.
Some healthcare providers have seen the light, and realized that it comes from a computer screen. As Boca Raton Regional Hospitalrecently demonstrated, providing an online infrastructure where you can engage your patients not only means they will be better informed and better prepared about the cost of their healthcare, it also results in increased collections and increased patient satisfaction.