Tag: Affordable Care Act

Almost every day, new developments come from Washington, D.C. regarding the U.S. healthcare system. From the Affordable Care Act and Medicaid expansion to laws and regulations governing cost transparency and debt collection — there's constant fluctuation. This affects healthcare organizations across the country. They don’t know what rules they’ll be operating under in the future, but they do know they’ll have to meet these changing laws and regulations to avoid fines or lost revenue. Consequently, a crucial question emerges: How do you comply without overburdening employees? Compliance with laws and regulations: 3 ways Experian Health can help The answer is in technology. Healthcare organizations need systematic changes and IT solutions that help establish stability and security. For example, Experian Health’s data-driven technologies help organizations remain compliant with laws and regulations while improving the population's health and ensuring more successful collections. Here are three ways Experian Health can help: 1. Early and accurate cost transparency Nearly 30 states have current laws and regulations that require and govern healthcare price transparency. This list will continue to grow, so organizations need to thoughtfully prepare. Even if it weren’t legally required, patients are now demanding more transparency as they bear more healthcare costs. Historically, the problem stems from patients not receiving accurate, upfront cost estimates. They’re surprised and dismayed when medical bills arrive weeks or months after treatment. If patients are unable to successfully budget for these high costs, then collecting payment becomes more difficult. Experian Health’s Patient Estimates solution solves this by producing fast, highly accurate estimates based on a variety of data. Employees don’t need to manually update price lists, which eliminates the guesswork that leads to outdated, inaccurate estimates. Patients can even self-request treatment estimates through a self-service portal or mobile app. When patients know what to expect before they receive treatment, they’re more willing and able to adhere to payment plans. With our Power Reporting feature, organizations can also accurately judge potential and actual revenue recovery to vastly increase the rate of successful upfront collections. 2. Ensured compliance of third-party vendors Accurate and upfront estimates make capturing revenue easier, but they don't eliminate the need for collections. With patients paying higher percentages of medical costs, healthcare organizations now rely more on agencies to collect debt on their behalf. However, if an agency doesn’t comply with all healthcare laws and regulations that govern debt collections, then it could be liable for its practices. The Fair Debt Collection Practices Act (FDCPA), the Telephone Consumer Protection Act (TCPA), and the Truth in Lending Act (TILA) are examples of these regulations. In addition to maintaining overall compliance in your organization, being responsible for a collection agency working on your behalf can be burdensome. This burden increases when a large percentage of your patients live out of state, making them harder to manage. 3. EMV-optimized payment solutions With more payments coming directly from patients, the risk of credit card fraud is exponentially higher. Healthcare organizations can be held liable for any fraud that occurs on their watch if they haven’t upgraded their systems to be compliant for EMV payments. To help avoid credit card fraud or liability, we offer state-of-the-art card acceptance devices. These are powered by our PaymentSafe technology to provide a patient payment solution that is highly secure and EMV-ready. Because PaymentSafe is processor agnostic, it can be integrated with Experian Health’s eCare NEXT suite of products to leverage the data created at other points in the revenue cycle. It also works in a standalone environment and can be used at a kiosk, through a patient portal, or on a mobile app to accept all forms of tender. PaymentSafe and other Experian Health solutions make up an advanced, integrated revenue cycle that consumes and displays information from a wide variety of sources. The goal is to increase collection opportunities and cash flow, lower the costs of collections, allow staff members to use their time more efficiently, and increase patient satisfaction. It also makes it easier to adapt to compliance regulations that can only be met with the help of advanced technology. The country's healthcare laws and regulations may be in flux, but Experian Health continues to help hospitals and medical groups keep up with safe and secure solutions. By providing increased price transparency, better oversight over debt collectors, and highly secure payment solutions, Experian Health’s suite of products can make navigating complex compliance laws and regulations a breeze. For more information about current laws and regulations in the healthcare industry, please visit: S. Department of Health & Human Services — Laws and Regulations overview Health Insurance Portability and Accountability Act (HIPAA)

Significant changes in health insurance coverage are delivering a good and bad news report for providers. The good news is the continuing decline in the number of uninsured Americans. As of January 2015, the current uninsured rate is at an historic low of 12.9%. Much of this decrease can be attributed to the Affordable Care Act (ACA), with 7.1 million people enrolled in a plan on the federal marketplace, as well as an estimated 2.4 million people who obtained insurance through state exchanges. Add to that young adults staying on their parents’ plans (3 million), another 10 million people who are covered through Medicaid and Children’s Health Insurance Plan (CHIP), job-based coverage and plans outside of the marketplace, and the picture should seem rosy. However, the bad news comes when these newly insured people begin using their benefits and are faced with deductibles, coinsurance and copays. Providers are seeing more patients with insurance coverage who find it challenging to handle these additional out-of-pocket expenses. Compounding the challenge is the increase in high-deductible health plans (HDHP) and/or health savings accounts. The number of people with HDHPs has risen from 19.2 percent in 2008 to 33.4 percent in 2014, as reported by the Centers for Disease Control and Prevention. Tackling the problem Healthcare providers not only have a mandate to provide care, most also are deeply committed to providing charity care when it is needed. However, in order to remain solvent, providers must protect their financial well-being by actively seeking reimbursement and payment when it is available and applicable. But, how can organizations strike the right balance? As a first step, having a system in place for assessment, enrollment and case management will not only help you maximize reimbursement by enrolling self-pay patients in Medicaid or qualifying them for internal charity care, it can also be used to document your facility’s charitable services. Key components to a well-orchestrated charity program include:  Screen for financial assistance using the most up-to-date qualification guidelines for Medicaid and other financial aid and charity programs. Ensures patients who are eligible for charity care, Medicaid and other assistance programs receive needed financial support. Determine a patient’s propensity to pay, so that you can evaluate payment risk, identify the most appropriate collection route and initiate targeted financial counseling discussions. Organizations can then maximize reimbursement dollars from Medicaid and other financial assistance programs and reduce uncompensated care and bad debt write-offs. Verify patient identity to reduce fraud risk, claims denials and the rate of returned mail – expediting reimbursement. This process streamlines the financial assistance screening and enrollment process to increase staff productivity as well as patient satisfaction. Through these strategies, organizations can more effectively identify patients eligible for charity, combatting ongoing patient financial responsibility challenges – or the bad news – while still capitalizing on the good news of more patients receiving coverage. Learn more about charity care initiatives by registering for our upcoming webinar, “Financial Screening in the age of the Affordable Care Act,” on March 11, featuring Brandon Burnett discussing Kaiser Permanente’s experience and initiatives and Kim Berg from Experian Health.

In the “good old days,” U.S. healthcare was basically free – at least that’s what patients with a good insurance plan believed. You may have had a small co-pay, but if you were employed, chances were that you and your family received comprehensive health insurance that took a barely noticeable bite out of your paycheck. Fast forward to 2014, and that rosy picture is long gone. Changing reimbursement models are compounding the financial risk for healthcare providers by placing a greater payment burden on patients. For example, a growing number of employers are adopting high-deductible health plans (HDHP) and/or health savings accounts. The number of people with HDHPs has risen from 19.2 percent in 2008 to 33.4 percent in 2014, as reported by the Centers for Disease Control and Prevention. Out of necessity, providers are finding themselves in the collections business if they are to protect the bottom line. One of the best tools at their disposal to increase full and fair payment for healthcare services, and which has long been employed by collections agencies? Data and analytics. Real-time information and advanced data and analytics can help identify the most effective and customized collections approach based upon each patient’s financial situation. This data gives healthcare organizations the full picture of a patient, providing continuous monitoring of unpaid accounts for changes in a patient’s ability to pay. Obtaining and effectively leveraging that information is just one best practice for healthcare organizations seeking to enhance their collections methodologies. Additional must-have strategies include: Management of internal collections and agency performance with real-time dashboards and reports, and support evaluation and performance improvement.  Use of full-time revenue cycle consultants and data analysts, who work with each account to recommend “best practice” collections and outsourcing strategies, evaluate reports for opportunities and oversee champion/challenger scenarios.  Tools that help detect hidden or additional insurance coverage from Medicaid, Medicare and commercial accounts.  Creation of customized patient statements that go beyond traditional statements by facilitating financial counseling, education and greater patient engagement.  Simplified and streamlined payment processes by collecting patient open balances anywhere and at any time through eChecking, signature debit, credit, recurring billing, cash, check or money orders.  Times may be changing, but employing a well-coordinated, proactive approach to addressing the self-pay patient and capturing the balance after insurance has paid doesn’t have to be challenging. Learn how Experian Health and Passport’s patient collections tools work together to help you obtain payment certainty even with today’s new reimbursement models, by combining unmatched insight, real-time data and innovative collections solutions.

Americans who do not currently receive health insurance through their employers or a government program such as Medicaid or Medicare are now required to obtain insurance coverage or pay a penalty tax per the Affordable Care Act’s individual health insurance coverage mandate. These consumers can go to newly created health insurance exchanges (HIX) — offered through the state or federal government, depending on where an individual lives — to enroll in a private insurance plan. It’s definitely a patient-driven process. So, how can healthcare organizations help? They can take advantage of this opportunity to improve the patient experience by connecting patients with much-needed insurance, while simultaneously mitigating patient payment risk. Today’s patients want to be armed with as much information as possible. With this new initiative, healthcare providers can help patients navigate the various options offered through the exchanges by calculating how much patients might spend on insurance and by providing a comparison of plan benefits. However, it’s important for healthcare organizations to take this process a step further by screening patients to determine if they qualify for federal subsidies and beginning the enrollment process. Assisting patients in this way not only improves the patient experience, but also benefits the hospital by getting more patients enrolled with insurance, ultimately leading to higher reimbursement for services provided. That leads to the next likely question: how can healthcare organizations successfully aid in this process? Solutions powered by data and analytics are the key. By using a data-driven approach to HIX screening and enrollment, an organization can identify patients that meet the income criteria for subsidy payments and tax credits, and automate the enrollment process by prepopulating the state’s HIX application form. In much the same way that data is used to screen for various financial assistance programs such as Medicaid or charity care, HIX screening uses key information about a patient’s unique financial situation to accurately determine if the patient qualifies for subsidies to help them pay for their insurance. Interested in learning how you can improve the patient experience when it comes to insurance coverage? Check out our newest product, HIX Screening and Enrollment, and see how it can help support your patients as they begin to navigate the new aspects of healthcare reform.