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Obamacare Deductibles Affect Medical Billing Efficiency

June 24, 2014

high deducible health insuranceThe growing necessity for people to buy high deductible health plans for cost control is a concern for billing reasons. Potential negative effects concern physicians and hospitals alike. The high deductibles, with a minimum of $1,250 for single coverage and $2,500 for family plans, are mandated by federal law, leaving little room for creativity.

Potential Negative Effects

There are two primary potential problems for medical practices associated with high deductible plans.

  • An increase in accounts receivable as patients struggle to meet deductible amounts
  • Potential decrease in physician quality ratings, resulting in delayed or denied claims

Both of these possible issues relate, directly or indirectly, to the efficiency of your billing function. If your medical billing procedures which starts with claim submissions are managed accurately, these potential problems should not occur. However, if you have not improved your billing and claim submission procedures, your practice revenue and quality ratings may suffer.

Issues with More Consumer Responsibility Enrolling in High Deductible Plans

  • Increased aging of accounts receivable;
  • Rise in bad debts, as consumers may not have the cash flow to pay higher deductible amounts;
  • Requirement to improve billing and collection policies and/or procedures to minimize revenue declines;
  • Greater focus on ‘point-of-service’ collection action; and
  • Creation of affordable patient installment plans to maintain practice cash flow levels.

With the graphic shift from fee-for-service to pay-for-performance (P4P) by the CMS and many private payers, you need to maintain evidence of delivering quality care, while improving your billing, claim submission and collection efficiency.

The provisions of the Obamacare aka Affordable Care Act (ACA), combined with dramatic deductible increases, P4P incentives or penalties and timely, accurate billing procedures, mandate that most providers make significant changes and improvements in their operating policies. Even if your practice historically functioned like a fine-tuned race car, the massive changes in the healthcare landscape demand that you should update your former procedures, however efficient they may have been.

Avoiding Negative Effects of High Deductible Health Plans

According to Forbes Magazine, the primary culprit is Obamacare. The increased financial demands on consumers because of federal mandatory healthcare coverage are the source, however unintended, of the shift to higher deductible plans. Compounding the issues is the continuing uncertainty of providers regarding the details of inputting sufficient information in electronic health records (EHRs) to verify delivering of quality care.

The following tips should help physicians and practices successfully navigate these ‘troubled waters.’

  • Design and install up-to-date billing and collection procedures that directly address these new challenges.
  • Thoroughly re-train billing staff on the new realities created by high deductible health plans.
  • Evaluate top third-party medical billing and documentation firms, such as M-Scribe Technologies, with a focus on finding a cost-effective solution to increased billing and claim documentation accuracy requirements.
  • Update former lax collection policies that may appear ‘haphazard,’ having your staff or third-party billing firm employ tighter patient and payer collection procedures and some fail-safe methods ensure timely, accurate billing.
  • Create high deductible health plan monthly installment plans to help patients meet their responsibilities, while maintaining sufficient cash flow to keep your practice profitable.
  • Closely monitor cash flow and accounts receivable aging for at least six months to give your staff and patients time to adjust to new billing and collection procedures.
  • Immediately address any negative trends you identify, making appropriate procedural ‘tweaks’ in your collection procedures.

While these suggestions to avoid high deductible health plan issues are not overly difficult to implement, physicians must be diligent in their follow-up and monitoring efforts to identify potential negative income trends. Should any problem be uncovered, providers must act quickly to find solutions before revenue slows dramatically.



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