In the last several years, the Affordable Care Act has changed how consumers access healthcare as well as how providers and the collection agencies they work with navigate the healthcare receivables landscape. Terry Rappuhn, a leader of the Healthcare Financial Management Association’s Patient Friendly Billing® Project, and a former hospital system CFO, recently discussed some of those changes from the perspective of a healthcare provider during her presentation, “Trends & Challenges: A Look at the Future of Healthcare Receivables,” at ACA International’s Spring Forum & Expo.
Healthcare receivables in 2015 and beyond are different than they have been in the past. Patients are expected to pay more of each healthcare dollar while regulators are focusing on medical debt, price transparency and financial assistance policies. An increase in self-pay for medical costs, high-deductible health plans as well as the final 501(r) regulations for nonprofit hospitals are some of the changes occurring as a result of the Affordable Care Act that collection agencies and providers need to work through. However, they also need to focus on the basics of meeting each other’s needs with the ultimate goal of resolving patients’ accounts.
Rappuhn said healthcare providers have several priorities when working with a collection agency to resolve patients’ accounts. “Trust and integrity are the most important things,” Rappuhn said. “They want you to match their collection philosophies and they want you to treat their patients like they do. I think in small communities this is really important because you see people you know more. It’s still important in the bigger communities because you are dealing with human beings having a medical crisis.”
Healthcare providers should clearly explain their collection expectations to their collection agency partners and the extent they would like them to connect with their patients. Rappuhn said other healthcare providers she’s talked with have also emphasized that it’s important for collection agencies working on behalf of a hospital or physician to engage with patients in a way that meets their needs while keeping in mind what the patient may be going through.
Some providers want their collection agency partners to be a one-stop-shop for information on resolving accounts, including balance owed after insurance and financial assistance policies, for example. Others want all patients referred back to the provider with questions about financial assistance to maintain that personal relationship.
Nevertheless, it’s important for agencies specializing in healthcare collections to understand the requirements providers have to work with their patients when it comes to insurance, billing and payments. They should also take into account the extent medical debt has become a problem for consumers, and consider helping by offering alternative payment methods.
During Rappuhn’s presentation, an attendee said more and more of his provider clients are asking for the collection agency’s input on handling patient accounts. Rappuhn said it’s important for collection agencies to discuss their client’s expectations with representatives in the revenue cycle department as well as leaders in other departments that interact with patients to make sure needs are met across the board—from collections to community relations.
Collection agencies working with healthcare provider clients should also be in tune with basic facts about their communities related to the Affordable Care Act and insurance plans. For example, it’s helpful for agencies to know if a Medicaid expansion under the Affordable Care Act has occurred in their state; the general types of community employers and insurance plans they offer; and if their healthcare provider clients are in-network or out-of network under those plans. Rappuhn recommended several resources to help providers and their collection agencies make sense of the healthcare and patient billing experience and, ultimately, better serve the patients. These resources include:
HFMA Price Transparency Task Force Report Clarifies basic definitions that are often misused. Sets forth guiding principles. Establishes roles for payers, providers and others. Reflects consensus of key stakeholders.
Patient Financial Communications Hospitals conduct sensitive financial discussions with patients. Now there are accepted, consistent best practices for these discussions, including: Encourage patients to talk with a financial counselor about their concerns. Identify additional or alternative insurance coverage. Determine how accounts will be resolved through conversation. Identify patients who fall under 501(r) regulations. Benefit from a satisfied consumer vs. an unhappy consumer.
Best Practices for Resolving Patient Medical Accounts from HFMA and ACA International Improve patient education and communication. Make bills patient-friendly. Establish policies for account resolution and ensure that they are followed. Report back to credit bureaus when an account is resolved. Track all consumer complaints. Use established HFMA and ACA best practices, principles and guidelines to inform your organization’s approach to medical account resolution.