3 Macro Health Payment Trends to Watch

Posted on June 5, 2014 I Written By

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
It’s not a stretch to say that the healthcare payment system has hit some tumultuous waters. Medical billing hasn’t been easy for a long time, but with things like the Affordable Care Act, Value Based Reimbursement, and the shifting world of data driven healthcare there is a lot you need to watch out for when it comes to getting paid. What does seem clear is that medical billing is not going to get any easier.

Let’s take a look at three broad health payment trends worth keeping your eye on:

Increased Patient Pay
One of the major trends in the health insurance industry is the move towards high deductible plans. Some of this change is coming from employers changing their plans and the ACA insurance exchanges are driving this trend as well. I see this shift continuing as healthcare and employers work to make the patient more accountable for their healthcare.

There are two main things you need to do to prepare for these high deductible plans. First, make sure you have a solid method in place to know how much the patient owes before or immediately after the visit. There is no better way to reduce patient collections than to collect the payment while the patient is in the office. Many are ready and willing to pay, but some practices don’t have the systems that allow them to know how much to charge the patient before they leave. Second, look at your processes for collecting patient payments once they’ve left the building. Do you have a good strategy in place to make sure the patient knows how much they owe? Do you have a variety of simple ways for the patient to make the payment? The use of an online payment portal for patients is the most obvious way to make submitting payment to physicians simple for patients. If you solve these two problems you’ll go a long way to improving your patient collections.

Higher deductible plans are here to stay and so an investment in systems that address the patient responsibility portion of the visit are incredibly important.

Data Driven Reimbursement
With the increased adoption of EHR software, you can be sure that insurance plans are going to want more and more data to justify your reimbursement. This is not a new trend for insurance companies. They’ve been requiring more and more documentation to justify payments forever. However, we’re at the point where what they’ll require will be so complex that you better have your documentation ducks in a row.

Certainly this means that if you don’t have an EHR or other technology infrastructure you will likely have issues. This will become particularly poignant as payers start to pay based on population health and value as opposed to the current fee for service model. I literally can’t see how insurance companies could switch to value based payments in a non healthcare IT world. The data in these systems is going to drive future reimbursement.

Newly Insured
Offices around the country are starting to see a set of newly insured patients thanks to the Affordable Care Act (ACA or Obamacare if you prefer). Are your office staff prepared for these new patients? While millions of uninsured patients are getting insurance and visiting your clinic, offices are also seeing many of their existing patients switching from a previous insurance to an ACA plan. Does your staff have the time required to update records? Not to mention, are you accounting for the extra time spent doing eligibility checks for these new insurance plans?

A MGMA survey of mostly independent physician practices recently found that 62 percent of practices are struggling to identify patients whose insurance came from the ACA exchange and to verify their eligibility or obtain plan details. Most practices also say that patients who got their insurance via an ACA exchange are more likely to have high deductibles and don’t understand that fact. Half of the practices say they can’t provide services to ACA exchange patients because their practice is out of network.

Can you see the potential problems to your practice? What will this new patient population act like when it comes to paying you for your services? Certainly a shift by existing patients to new high deductible plans will cause issues like increased patient responsibility that we talked about above. However, the newly insured population is being shifted from the ER to your offices. If you consider the history of ER payments by patients, there’s reason to be concerned about how well this new patient population will do at paying their portion of the bill.

Plus, we’ve seen many practices that are finding it really difficult to determine their participation status with the payer. It seems that payers have cherry picked providers for their new narrow exchange networks and haven’t informed providers of whether they’re in or out. Once you finally do determine you par status, be sure your staff can recognize the new insurance cards so they can flag them or potentially turn them away if the provider isn’t par.

These are just a few of the major healthcare payment trends I see happening in the industry. I’d love to hear in the comments what trends you see happening in your offices. What other things should we be aware of in this constantly shifting healthcare payment world?

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.