The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
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 …read more
