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How Consumers are Driving Reimbursement Trends in Medical Practices

January 19, 2016

Consumer_and_healthcareHigher deductibles and increased out-of-pocket costs for consumers

The passage of the Affordable Care Act (ACA) and related insurance reforms with reduced insurance premiums for those who qualify has resulted in many more insured Americans. The downside for healthcare consumers is increased personal responsibility for post-reimbursement costs as a higher share of the expense burden is shifted to users of healthcare services.

These expenses, usually in higher deductibles and co-pays, can pose a real hardship for families whose income doesn’t qualify them for reduced premiums. Healthcare consumers, in particular those in well-populated areas where more choices may be available, are becoming more inclined to shop around for healthcare services as well as affordable insurance plans.  

An increased awareness among consumers of care options and rights

The U.S. Department of Health and Human Resources (HHS) Agency for Health Research and Quality reports that as part of this personal responsibility shift, consumers are also beginning to ask more questions of their providers regarding diagnosis, treatment and medications as well as getting second opinions. They are no longer taking for granted that a particular test or procedure is the only option available.  

The agency encouraged consumers to explore all options and become a pro-active partner with health providers by giving them information which may not always be shared between providers. The agency also urged consumers to take an active role in maintaining wellness by following healthier lifestyles, such as not smoking, getting appropriate exercise and losing weight.  

More mobility than in previous generations among young adult consumers and retirees

Younger people are increasingly on the move due to job relocation requirements; elderly patients who may relocate seasonally from winter to summer homes all underscore the need for improved distribution of patient information between providers.  These frequent moves as well as changes in insurance carriers also contribute to gaps in communication between providers, creating additional challenges for medical practices striving to meet HIPAA privacy regulations while ensuring that benchmarks for care quality are met.  

The impact of young adults in healthcare planning services and reimbursement

Younger adults becoming established in their careers as well as facing the expenses of starting families or struggling with college debt, are a willing market for reductions in healthcare expenses. Innovative payment methods and ‘rewards’ plans by providers and insurance companies should find many takers among younger adults.

As less-frequent users of healthcare services overall than other segments of the population, an HRI study revealed that over 50 percent of young adults between the ages of 18 and 34 would be interested in services helping them to plan for the costs of medical care.

How Will Obamacare Affect Reimbursement Rates for Medical Practices

Billing and reimbursement challenges

Providers grappling with point-of-service payments are finding it necessary to embrace a new set of consumer-oriented services and payment options, including more ‘creative’ methods of controlling costs with innovative ways to attract and keep patients. Knowing that patients are seeking greater transparency in pricing as well as payment options including offering financial assistance or financing similar to those by Novant Health, improve patient peace of mind as well as collection rates.

Incentives and rewards

Incentive and rewards plans such as those offered by Walgreen’s Balance Rewards program, allow consumers to earn points through enrolling in Health Savings Accounts and combining various activities into a single incentive program. Marketplaces like SpendWell Health offer better pricing transparency for services such as colonoscopies and joint replacements.

Medical Practices faced with meeting these and other reimbursement challenges can turn to M-Scribe Technologies, LLC, for complete billing, coding, documentation and other revenue management services. Contact us today to learn how our technology and expertise can improve your practice’s compliance and collection rates.


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