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Healthcare Finance News Editor Richard Pizzi recently interviewed two healthcare reimbursement experts about trends in accounts receivable management in 2011. Chaim Indig is the co-founder and CEO of Phreesia, a New York-based firm specializing in patient intake technology, and Bill Gilbert is vice president of marketing at Warren, N.J.-based medical billing technology and services vendor AdvantEdge Healthcare Solutions.
Looking back at 2010, what were the major issues for healthcare ARM?
Chaim Indig: Prior to 2010, everyone was focused on payer receivables, but last year we started to see customers talk more about the importance of patient receivables. And not just large dollar amounts, but frequent dollar amounts. Also, physician practices have begun to realize that patient co-pays are a significant contributor to total margin. As soon as you begin sending letters out to patients requesting payment, the costs begin to rise. We also saw an increasing number of institutions spending more time verifying insurance in 2010, but also finding that throwing more staff at the problem was not solving it. Organizations wanted to leverage technology tools to complete tasks like that.
Bill Gilbert: The increase in the patient-responsible part of the medical bill was a big issue. There was a double-digit increase in high-deductible health plans in 2010 and traditional plans declined anywhere from single to double digits. You’re seeing a change in the makeup of coverage, which means the billing and collections process gets more complicated. The other thing that jumps out in 2010 is all the back-and-forth related to SGR in Congress. Physicians were caught in between, not knowing when and if it was going to be fixed. The net effect of that has been that some physician groups have capped their Medicare patients at a certain percentage, while others aren’t taking any Medicare patients.
Will most of these issues carry over into 2011?
Gilbert: I believe HDHPs will be an increasingly important issue this year. I’d be surprised if there were not another double-digit increase in those types of plan. You’ll see continue to see larger deductibles, co-pays, and co-insurance.
Assuming that there is an increase in patients with HDHPs, what practical tips do you have for physician practices in dealing with that issue?
Gilbert: We strongly encourage practices to do an eligibility check when they confirm appointments with patients. As part of the eligibility check, they should cover the co-pay with the patient. We’ve found that some patients sign up for a plan with a lower premium, but they don’t understand the implications – in some cases a very high deductible. A little bit of patient education can be very helpful. It’s hard to get hospital admitting to do that, but the same logic applies.
What other issues will providers encounter in 2011?
Gilbert: On the complexity front, is the testing for HIPAA 5010. That promises to be rocky, like any major transition. That standard has to be fully in place by the beginning of next year, but there will testing this year. And the ICD-10 transition is on the horizon. That doesn’t take effect until 2013, but if practices aren’t starting to prepare, it will be pretty painful.
Indig: An increasing number of facilities are putting patients on payment plans. That used to be a small percentage, primarily related to low income patients. But we’re seeing more of these plans being offered to middle class Americans now, and that is due primarily to the rise of high deductible plans.
Gilbert: One invisible thing is the impact of rates that practices can negotiate with each insurance company, particularly the commercial companies. In some cases, the commercial companies have grown more aggressive with their strategies to push reimbursement rates down. Physician practices have to be well prepared when its time to renew contracts, and not take that process for granted. There’s constant tension, even in the best of circumstances.