Potential Consequences of Forgiving Copayments

Back in the day, before health insurance entered the market, patients negotiated directly with healthcare providers and paid what they could afford, often on a sliding scale. Deductibles, copayments, and coinsurance developed as a check against overutilization once insurance companies became responsible for the bill.  These days, many insurance companies are increasingly checking up on the collection of copayments, deductibles and coinsurance by asking for proof of payment collection.  And in certain instances, especially in times of financial hardships, some providers do indeed waive copayments for their patients (yet still bill the insurance companies for services).

With the upcoming changes in the industry, it’s especially important for providers to understand the rules regarding the waiver of copayments.  Providers should be aware that forgiveness or waiver of copayments may violate policies of some insurers, both public and private.  It’s especially important to note that routine waiver of copayments may constitute fraud.  With the ACA rollout expected to be in full swing by the next year, providers should make it a priority to not only update their financial policies, but also to place an emphasis on patient responsibility.

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Inaccurate Pricing Info on Access Health CT Website

Officials have discovered that when the Access Health CT website went live on October 1, the website contained inaccurate pricing information.  The staff at the exchange was aware of the incorrect information when the site went live but Lt. Gov. Nancy Wyman and Access Health CT CEO Kevin Counihan did not mention it when asked about pricing information.  The inaccuracies regarding deducticles and co-insurance rates impacting all 19 health plans were discovered on September 26.  Counihan notified the Connecticut Insurance Department about the problem and it was then that officials decided to place a warning on three locations on the site.  The problem could have impacted around 2,400 residents who signed up through the website.  It is unclear how and why incorrect information was coded into the system. Shopping screens were corrected by October 30th.

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6 Tips for Picking the Right Health Insurance

If you’re still confused about picking the right health insurance, don’t worry! Here are some quick and easy tips to consider when picking an insurer:

  1. Look at options both on and off the exchange.
  2. Get the summary of benefits and coverage form (SBC) which lists information about the different health insurers.
  3. Look at the price, not just the price of the premium but also other out-of-pocket expenses like co-pays.
  4. Look at provider networks to see if your doctor is covered, especially if you need out of network benefits (from providers like psychologists and chiropractors, for example).
  5. Check to see if your medications will be covered and if they will, what the cost will be.
  6. If you are still confused about choosing the right provider, consult with an insurance broker.

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Breaking News: Connecticut to Make Decision on Health Plan Change Today

A few states including California, New York, and Massachussetts have decided that they will not allow consumers with canceled plans keep their insurance under the ACA. Governor Malloy will decide today whether he will follow their lead or let Connecticut residents keep theirs. In the past, he has been critical of President Obama’s decision to allow consumers to keep their insurance.  Malloy will announce his decision outside the car show at the Connecticut Convention Center later today.

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Bundled Payments Reduce Costs, Boost Transparency

Bundled payments have “generated increasing momentum across the healthcare industry as a way to reduce costs and boost transparency” according to surveys of insurers, patients, providers, and employers.  Bundled payments are known to improve outcomes and reduce costs, benefiting patients and employers, as well as payers and providers.  A survey by Booz & Company found 31 percent of the 58 participating insurers are pursuing them while 47 percent are interested in the payment model.

Click here for our series on bundled payments!

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HMS Exclusive: What Happens if a Privately Insured Individual Doesn’t Pay His/Her Premium Under the ACA?

We’ve been hearing a lot about the insurance exchange and the enrollment process.  But, there has been very little discussion regarding insurance premiums and the privately insured, specifically, the consequences of a privately insured individual who is unable to pay his/her premium on time.  Of course, this isn’t an important matter for people insured through their employer since most employers tend to pay premiums on time (or it’s automatically deducted from employees’ paychecks).   So, what happens when an individual buys insurance through the exchange but then does not pay the premium?

According to experts, insurance companies have “contract language” with hospitals and physicians which allows for a 90 day grace period for a patient who has an exchange plan and then suddenly stops paying his or her premium.  For the first 30 days, the insurer is required to continue to pay claims but in the last 60 days, payment can be withheld.  What does that mean? If a patient fails to pay the premium, they’ll lose coverage at the end of 90 days and physicians will not get paid!

This will significantly impact doctors and hospitals so it is extremely crucial that providers have a plan in place to prevent nonpayment.

HMS recommends your practice does the following to help ensure you get paid for your services:

  • Accept major credit cards
  • Collect all applicable copays and applicable deductibles at the time of service
  • Have strict financial policies in place that clearly outline practice expectations with regards to patient responsibilities. These should be signed by patients acknowledging that they understand the policy and all obligations related to it
  • Payment plan options
  • A collection agency relationship
  • Financial hardship policies

HMS emphasizes that you communicate with your patients the importance of them understanding their policy/contract so that they can be prepared to meet their responsibilities (i.e. co-pays, deductibles, premium dude dates, and the terms of which they can be terminated).

If you have questions and/or concerns, please contact HMS at (203) 294-6659.

Breaking News: CT Physicians Suing United Healthcare

We recently told you about United Healthcare dropping thousands of Connecticut doctors from its Medicare Advantage plans (see here).  Well, it looks like some doctors have chosen to do something about it.  Two medical associations filed a suit this week accusing the insurance company of breaking Medicare regulations and contracts with its providers.  The associations, comprised of the Hartford County Medical Association and the Fairfield Medical County Association, representing 3,300 doctors, are asking the court to grand an injunction preventing UHC from enforcing its contract amendment.

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HHS Extends Application Deadline For Insurers

Earlier today, the Department of Health & Human Services (HHS) announced the deadline for health insurers to submit applications to sell insurance in the states where the federal government is running health insurance exchanges has been extended by three days until this Friday.

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Revenue Cycle Management Series: Appointment Scheduling

It’s important to understand the impact appointment scheduling can have on the revenue cycle process.  Since scheduling is the first contact a patient has with the office, it’s crucial the experience be a positive one. Staff responsible for scheduling appointments must be friendly, helpful as well as knowledgeable.  Here are some guidelines to ensure appointment scheduling goes smoothly.

  • Information Gathering: Be sure to collect the patient’s name, contact information, insurance coverage and purpose of the visit.
  • Verify Coverage: Patient insurance information should be verified before the first visit.
  • Ask Questions: Attempt to determine the payer responsible for the services.
  • Financial Obligations: Communicate patient financial responsibilities up front, including copay and co insurance benefits for out of network providers.
  • Insurance & Demographics: Many services require prior approval from the insurance carrier in order for the service to be reimbursed. Following this step is important to ensure a claim won’t be denied.

Appointment scheduling is also a critical time to effectively manage the providers schedule by identifying the reasons for services and organizing the schedule to maximize efficiency of patient flow for the day.  Following these simple steps can maximize revenue and reduce the risk of patients not showing up for appointments

Stay tuned for the next installment of the HMS Healthcare Management Solutions Healthcare Revenue Cycle Management series when we will explore the registration process.

Tiptastic Tuesday: Understanding Medical Bills

Medical bills can be confusing for patients.  Below are five easy steps medical practices can apply to help patients understand their medical bills and be better prepared to handle them.

  • Educate Staff:  Make sure office staff knows what plans your providers are associated with and understands the differences and complexities between different insurance companies
  • Use Eligibility Technology:  Today’s technology completely automates the process of checking patient insurance. Having these details at your fingertips will help inform staff about the patient’s responsibility.
  • Share Insurance Eligibility With Patients: Require staff to share the specifics of a patient’s insurance with the patient. Explain the expectations your practice has for patients including what part of the payment is expected at the time of visit and what portion will be billed after the visit.
  • Provide A Sample Statement:  Give patients a sample bill so they can familiarize themselves with your statements. Describe each area of the statement and provide an accompanying to create handout that explains the information in detail.
  • Explain Insurance Basics:  Don’t assume a patient understands all of the basics of insurance. Train your staff to be able to clarify these things with patients.