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Pulse Magazine

Pulse Magazine

News & Notes

CMS: The Impact of Cost on Health Coverage

Recent reports from the Centers for Medicare and Medicaid Services show health insurance enrollment trends, including the impact of healthcare cost and affordability on consumers.  The Effectuated Enrollment report shows nearly two million people, after selecting a plan through health insurance exchanges, did not pay their health insurance premium to maintain health coverage in early 2017, citing cost as the primary reason. Read more here:


Study: Who is at Risk for High Out-of-Pocket Costs

A growing number of consumers with employer-sponsored health insurance and their families are paying more out-of-pocket for healthcare, according to Kaiser Family Foundation research. For example, nearly 25 percent of workers spent $1,000 or more on healthcare services and more than 1 in 10 spent over $2,000 in 2015.  “This represents a growing fraction of patients over the last decade, with the share spending $1,000 or more rising from 17 % to 24 %.”


We Want to Hear from You

Pulse is published for ACA healthcare collection agencies to provide current industry information for healthcare providers. ACA International welcomes article ideas and submissions for consideration in Pulse. Ideas may be submitted to ACA’s Communications Department at

Healthcare Organizations Lack Focus on Cybersecurity as Risks Continue

Healthcare provider organizations are lacking in planning and leadership for cybersecurity programs, according to results from a fourth quarter 2017 survey conducted by Black Book Research.  More than eight in 10 provider organizations surveyed do not have a “reliable enterprise leader” for their cybersecurity programs, according to a news release from Black Book™.

Results from payers, however, show more interest in cybersecurity planning.  “When it comes to payers, 31 percent have an established manager for cybersecurity programs currently, with 44 percent planning to recruit a candidate in the new year,” according to the news release.  However, Black Book™ also reports the healthcare industry is underestimating security threats and organizations are hesitant to adopt best practices for cybersecurity.

Fifty-four percent of respondents revealed they do not conduct regular risk assessments and 39 percent said they don’t test their security firewalls on a regular basis.  “The low security posture of most healthcare organizations may prove a target demographic for which these attacks are successful,” Doug Brown, managing partner of Black Book™ said in the news release.

This lack of planning is concerning given that the healthcare industry is one of the top targets for data breaches recently. Among the larger-scale healthcare security incidents in 2017 (, a Verizon data breach in 2017 resulted in the release of a private database affecting 14 million customers; and patient data, including their name, Medicaid ID number and more, for 1.1 million people was inadvertently made public through a live hyperlink in an Indiana Health Coverage Program Report.

Findings from the November 2017 Protenus Data Breach Report ( show there was at least one healthcare data breach per day since the beginning of 2017.  The U.S. Department of Health and Human Services (HHS) Office for Civil Rights continues to monitor the issue of cybersecurity in healthcare and stresses data breaches caused by insider threats are a recurring issue. (

Cybersecurity tips from HHS include:

Consider using logs to document whenever access is granted (both physical and electronic), privileges increased, and equipment given to individuals.

Consider having alerts in place to notify the proper department when an account has not been used for a specified number of days.

De-activate or delete user accounts, including disabling or changing user IDs and passwords. “When an employee or other workforce member leaves, it is extremely important that coveredentities and business associates prevent unauthorized access to protected health information (PHI) by ensuring that the former workforce member’s access to PHI is effectively terminated,”HHS reports.

ACA International will host its two-part Data Security and Privacy seminar, including tips for implementing effective policies and procedures, in March. Visit our Events calendar for more details and to register. https://www.acainternational.

Technology, Price Transparency are Critical to Meeting Patient Demands

Patients want more options when it comes to healthcare financing, engagement with providers and price transparency, according to results from the Black Book2017 Revenue Cycle Management surveys.  The surveys are the result of a research study “designed to trend consumer satisfaction and patient experiences, as well as uncover payment challenges and strategies for provider organizations,” according to a news release.

Black Bookpolled both patients and providers in the second and third quarter 2017 with consumer surveys designed to determine how patient responsibility for medical bills, which has increasingly shifted from employers to patients, is impacting providers’ revenue cycles. The surveys included 2,698 healthcare providers and 850 consumers with high deductible health insurance plans.

Eighty-three percent of providers surveyed plan to address the increase in “patient consumerism” by offering more “retail-like technology solutions and practices.”  “Emerging healthcare pay trends reveal the opportunity to help patients better anticipate, manage and track the costs of their care,” Doug Brown, managing partner of Black Booksaid in the news release. “Innovative patient-friendly payment solutions that meet consumer preferences and enable fast transactions are playing a key role in this transition.”

Since 2015, according to Black Book’sfindings, patients experienced a 29.4 percent jump in their deductibles and out-of-pocket costs. The average deductible for consumers in 2017 was $1,820 and out-of-pocket costs increased to more than $4,400.  With consumers’ increased costs and rising unpaid medical bills, healthcare providers are turning to new strategies and technologies to recover those funds.

“Survey findings from 1,595 physician practices, 202 hospitals and 49 health systems reveal profit margins continue to be impacted negatively by traditional collection solutions, steering 82 percent of medical providers and 92 percent of hospitals to jettison time-intensive, error-prone, manual efforts to back end process and reconcile bills by Q4 2018,” according to the news release.

The surveys also show consumers prefer to pay their bills online. In the first half of 2017, nearly 62 percent of medical bills were paid online and 95 percent of those surveyed said they would use that option if available from their healthcare provider, according to the news release.  “Employing these solutions at the front end of the revenue cycle has given patient risk to providers and the attention has turned to establishing funding mechanisms to benefit not only the hospital or physician, but the consumer,” Brown said.  “Patients truly are the new payers.”

Additional key findings in the surveys include:

*Eighty-nine percent of provider financial administrators expect that healthcare payments will be made on phones and mobile devices by the fourth quarter 2018, however only 20 percent have the systems in place for electronic payments.

*Eighty-three percent of offices with under five physicians report “the slow payment of high-deductible plan patients are their top collection challenge, followed by the difficulties that practice staff have at communicating patient payment accountability (81 percent).”

*Patient payment services in high demand, according to healthcare providers, are transparency via cost estimation, managing consumer expectations through insurance eligibility verification before an appointment and enhancements to make payments more convenient for patients.

More information: and

Texas Law Expands Protections for Medical Account Mediation

The New Year rings in new protections for certain medical claims. Last year, Texas Governor Greg Abbott signed legislation to expand the existing law dealing with balance billing, which occurs when patients are directly billed by a provider for the portion of medical expenses not covered by their insurance.

This can happen when insured patients receive out-of-network care, often in an emergency care situation or when a patient is admitted to an in-network facility, but receives treatment from an out-of-network provider.  Texas developed a mediation system back in 2009 to assist consumers in resolving certain balance bills and made improvements to the system in 2015, and most recently again in 2017.

The most recent legislation, which applies to claims incurred after Jan. 1, 2018, broadens the types of accounts that are eligible for mediation protections already used by insured consumers in Texas on a limited basis. The newest law expands access to mediation eligibility to all out-of-network providers treating patients at in-network hospitals and other facilities.

Before the latest revisions, the existing law made mediation available to consumers who were balance billed by only six types of facility-based providers: radiologists, anesthesiologists, pathologists, emergency department physicians, neonatologists and assistant surgeons. The law also provides for mediation of balance bills for emergency care from any provider or facility of emergency services care, including freestanding emergency rooms.

In an effort to bolster awareness of the mediation program, the new law also institutes a new disclosure requirement to inform consumers of their mediation rights. Healthcare providers and other facilities must include a statement substantially similar to the following: “You may be able to reduce some of your out-of-pocket costs for an out-of-network medical or health care claim that is eligible for mediation by contacting the Texas Department of Insurance at [website] and [phone number]” on bills that are eligible for mediation. The disclosure must be in at least 10-point boldface type.

Healthcare and emergency services providers should make sure they are familiar with the new balance billing requirements that apply to certain healthcare claims incurred on or after Jan. 1, 2018, and determine how they will impact current billing practices.  Please note that the above-referenced legislation, S.B. 507, became law on Sept. 1, 2017, and applies to healthcare claims incurred after Jan. 1, 2018.

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