Mnet Health News delivers the latest news and information articles for the world of healthcare.

A+ A A-

IRS Revokes Nonprofit Status from Hospital Under 501(r)

The Internal Revenue Service (IRS), for the first time since regulations for tax-exempt hospitals went into effect in October 2016, has revoked the nonprofit status for one hospital.  Nonprofit hospitals are required to comply with the Internal Revenue Service’s 501 (r) rules, including completing a community health needs assessment and meeting financial assistance policy requirements. Hospitals subject to 501(r) must also adhere to limitations on charges and follow billing and collection practices under the requirements, ACA International previously reported in the January 2016 issue of Pulse.

According to a report from FierceHealthcare, “The IRS deemed the hospital ‘egregious’ for its failure to meet the requirements, concluding that it had ‘neither the will, the resources, nor the staff to follow through’ with them.”  The IRS issued a letter to the hospital for the revocation in February 2017 and released it on their website in August.  The primary reason for the revocation, according to FierceHealthcare, is the hospital failed to make its community health needs assessment available to the public online.

The letter states: “You are a hospital organization which with the requirements of IRC section 501 (r), to conduct a community health needs assessment, adopt an implementation strategy and make it widely available to the public.”  It also states the hospital is a small rural facility without the financial or staffing resources to dedicate to meeting the requirements of 501 (r) and the community health needs assessment.

Under the Affordable Care Act, the IRS is required to review activities at tax-exempt hospitals once every three years.  Requirements, previously reported in Pulse, for a hospital to maintain its nonprofit status, set by the IRS and mandated by the Affordable Care Act, include:

Establishing written financial assistance and emergency medical care policies.

Limiting amounts charged for emergency or other medically necessary care to individuals eligible for assistance to not more than amounts billed to people with insurance for the care.

Determining if an individual is eligible for financial assistance before using extraordinary collection practices.

Conducting a community health needs assessment and adopt an implementation strategy at least once every three years.

Jan Smith, a tax senior manager in Crowe Horwath’s Healthcare practice, said in an interview with the Healthcare Financial Management Association (HFMA) that it is unlikely this action by the IRS will set a precedent for revoking nonprofit status of other hospitals.

“If hospitals are making a good-faith effort to comply, I would be surprised if the IRS would revoke their tax status at this stage of 501 (r) examinations,” Smith said in the interview with HFMA.  More information: http://ow.ly/uhRX30eAJylhttp://bit.ly/2v7F79R and http://bit.ly/2w5LMVH.

Read more...

'Balance Billing’ From Providers Shows Need for State, Federal Protections

Consumers in some states are receiving “balance bills” for healthcare if they are treated by an out-of-network provider not covered by their health insurance plan, according to an issue brief from The Commonwealth Fund.  “Privately insured consumers expect that if they pay premiums and use in-network providers, their insurer will cover the cost of medically necessary care beyond their cost-sharing,” The Commonwealth Fund reports in the brief, Balance Billing by Health Care Providers: Assessing Consumer Protections Across States. “However, when obtaining care at emergency departments and in-network hospitals, patients treated by an out-of-network provider may receive an unexpected ‘balance bill’ for an amount beyond what the insurer paid. With no explicit federal protections against balance billing, some states have stepped in to protect consumers from this costly and confusing practice.”

The Commonwealth Fund researched the issue to better understand the state laws to protect consumers from balance billing by an out-of-network provider and found that most states do not have laws in place.  “Of the 21 states offering protections, only six have a comprehensive approach to safeguarding consumers in both settings, and gaps remain even in these states,” The Commonwealth Fund reports. “Because a federal policy solution might prove difficult, states may be better positioned in the short term to protect consumers.”

Private health insurance purchased by consumers is a mechanism to offset the high cost of healthcare.  “They expect that if they pay their premiums and use in-network providers, their insurer will cover the cost of medically necessary care beyond their specified copayments, coinsurance, and deductibles,” according to The Commonwealth Fund.  However, if consumers are treated by an out-of-network provider, such as during an emergency room visit, they may face extra costs. 

Out-of-network providers do not have contracts with health plans and therefore no negotiated payment rates, according to The Commonwealth Fund.  In some cases, consumers will receive “balance bills” totaling thousands of dollars when an out-of-network provider issues a charge that is the difference between health insurance coverage and doctor’s fees.  And, oftentimes when a consumer is cared for out-of-network, they did not have a choice about the provider.

Research published in Health Affairs Web First, “One in Five Inpatient Emergency Department Cases May Lead to Surprise Bills,” cited by The Commonwealth Fund shows 14 percent of emergency department visits and 9 percent of hospital stays were likely to result in an unexpected bill. Twenty percent of patients admitted to the hospital from the emergency department were likely to receive an unexpected bill, according to the research.  Additional findings in the issue brief include: 

Twenty-one states have “direct protections” in their statutes or regulations for consumers who would be subject to balance bills as a result of out-of-network care, however they do not prevent balance billing for consumers in all situations;

Six states—California, Connecticut, Florida, Illinois, Maryland and New York—have a comprehensive approach to protecting consumers, including “holding them harmless from extra provider charges and prohibiting providers from balance billing;”

In 12 states, “balance-billing protections only require insurers to hold consumers harmless from the billed charges of providers but do not prohibit providers from sending bills.  Because these states do not prohibit providers from balance billing, consumers may still receive a bill from a physician, hospital, or other provider.” In those states, Colorado for example, regulators have reported consumers receive balance bills and may not understand their rights not to pay.

Additionally, in 29 states and the District of Columbia, there are no laws or regulations “that explicitly protect consumers from unexpected balance billing by out-of-network providers in [emergency departments] or in-network hospitals.  The Commonwealth Fund concludes in the issue brief that balance billing can create financial troubles as much as impact consumers’ views on the healthcare system.

“Consumers expect that their health insurance will cover the cost of most medically necessary care beyond their cost-sharing amounts. But when emergencies or other unexpected circumstances expose them to out-of-network providers, balance billing can create financial burdens and undermine their confidence that health insurance will protect them from financial hardship,” it reports.

“Concerns about balance billing are not new but may be growing as the use of narrow provider networks becomes increasingly common. The fact that consumers are more likely to experience balance billing in situations where they have no control over which providers treat them suggests that additional state and federal policy solutions are needed to protect consumers fully and limit financial risk.”

 

Read more in the issue brief here:  http://ow.ly/esqL30cQIqA

 

 

 

Read more...

How High-Deductible Health Plans Influence Providers’ Collections

The prevalence of high-deductible health plans and a growing gap between self-pay and insured patients are continuing to influence healthcare providers’ collections on their accounts, according to a new report, “Revenue Recognition and High-Deductible Plans: The Greater the Patient Portion, the Lower the Collections,” prepared by Crowe Horwath, LLP.

“In what appears to be an ongoing evolution of self-pay customers, the collections gap between uninsured accounts (‘true self-pay’) and the patient responsibility portion on insured accounts (‘self-pay after insurance’ or SPAI) is widening,” according to the report.  Crowe Horwath analyzed a sample of 172 hospitals in its benchmarking database to determine the number of hospitals separating patients into payer groups, including “true self-pay” and “self-pay after insurance.”  It found that 74 percent of those hospitals, each with more than 125 beds, separate patients into the two payer groups.

Collections from patients with “very” high-deductible health plans are becoming similar to those of traditional uninsured patients in some cases, according to the findings in the report.  “The Crowe benchmarking data reveals that true self-pay patients generally pay approximately 6.06 percent on the dollar, while self-pay after insurance patients pay approximately 15.51 percent overall,” according to the report.  Overall, more consumers have enrolled in high-deductible health plans over the last two years and healthcare providers are struggling to secure the amounts owed by patients.

“The percentage of collections on patients with account balances greater than $5,000 is four times lower than collections on low-deductible plan patients,” according to the report.  “Hospitals have traditionally separated insured patients and uninsured patients into different portfolios when conducting financial analysis,” said Brian Sanderson, managing principal of Crowe healthcare services group. “However, recent findings indicate that very high-deductible plan customers may pay at a rate more similar to that of uninsured patients.”

Crowe Horwath also analyzed self-pay after insurance accounts based on inpatient or outpatient services.  Key findings on inpatient self-pay after insurance include:

Patient account balances less than $1,200 have a payment rate of 40.1 percent.

The payment rate drops significantly—to 17.6 percent—near the inpatient Medicare deductible amount of $1,201 through $1,450, where Medicare bad debt may have implications on collections, according to Sanderson.

The payment rate for higher deductible health plans with balances of $1,451 through $5,000 is 25.5 percent.

The payment rate drops to 10.2 percent for balances of $5,001 through $7,500, 4.1 percent for $7,501 through $10,000, and 0.9 percent for accounts with a self-pay balance at more than $10,000. 

Findings on outpatient self-pay after insurance payments also vary significantly across different segments, according to the report:

The average self-pay payment is 18.2 percent across all outpatient accounts receivable (AR).  

A significant increase exists in the percent of self-pay after insurance outpatient AR residing in the $10,001 through $500,000 segment—from 14.6 percent of AR in 2015 to 29 percent of AR in 2016.

The outpatient payment rate is 23.7 percent on AR between $1 and $5,000.

The outpatient payment rate is 4.7 percent on AR between $5,001 and $7,500.

“While average patient balances for high-deductible plans increase, payment collections vary based on the size of the balance,” the report concludes.  “As healthcare providers analyze the ‘realization’ (i.e., the percentage of net revenue versus gross revenue) of their managed care contracts, they also should understand risks associated with high-deductible plans and should recalibrate their AR valuation and potential impacts on revenue recognition to account for these new market factors.

Parsing accounts based on patient balance will prove a particularly insightful analysis for any finance team and likely will create a more reliable collectability factor based on historical experience.”  

More information:  http://ow.ly/SE7h30bk1O0

Read more...

Managing Patient Payments: A Balancing Act (Part 2-The Future of Patient Financing)

Consumers want clear explanations of their bills and options after they receive care as much as they do when they evaluate costs at healthcare providers in advance, according to the 2016 Healthcare Consumerism Study by ClearBalance.

Fifty-five percent of the respondents in 2016 said they are sometimes or always confused by medical bills and 61 percent reported they are sometimes or always surprised by out-of-pocket costs they owe, according to the survey.

Additionally, 65 percent of respondents said clear, easy-to-understand medical bills would have a positive impact on selecting a healthcare provider.

Patient financing options are important as healthcare providers are seeing reduced reimbursement for care, meaning patients have a greater responsibility for their bills and may not have the ability to pay for a high healthcare expense, especially if it is unexpected.  According to athenahealth’s research, 50 percent of providers fail to receive at least $23,000 a year from patients. Forty percent of providers fail to receive more than $31,713 a year from patients.

There are best practices that can help improve collecting from patients, including evaluating patient pay measures such as time-of-service collection rate as well as the number of self-pay days in accounts receivable and bad debt write-offs, according to athenahealth.

According to Haupt in his presentation and ClearBalance Patient Pay Research from June 2014, payment plans can lower bad debt and provide better patient satisfaction. Reducing bad debt and improving patient satisfaction are the top two factors influencing providers’ decisions to offer patient financing options followed by reducing accounts receivable days, immediate cash flow, eliminate collections costs and improving staff and physician satisfaction.

Providers can also identify tools such as training staff, developing a collection plan before a patient’s office visit, time of service collections through card-on-file agreements or payment plans for large balances, and ongoing collection plans to help keep patient payments on track in a way that works for everyone, athenahealth concludes in its research.

For example, athenahealth reports payments plans for patients with high balances on their accounts “are essential for increasing overall collections, especially for practices whose patients are responsible for a substantial portion of the total cost of care.”  Healthcare providers with uninsured patients or a high percentage that have high deductible health plans can also consider time-of-service collections and even a set down payment from the patient, according to athenahealth. 

Card-on-file agreements can also be helpful in collecting patient obligations at time-of service.  Even if the patient’s bill amount is not known, providers and patients can agree to a payment range that will be collected.  “We really are in a two-payer market, with government and commercial payers in one bucket and patients in another,” Haupt explained. 

Providers still must collect from commercial and government payers. As reimbursement tightens from that payer category, providers have no choice but to ensure they collect as much as possible from the second payer category – the patient – to maintain their financial health.

Overall, according to ClearBalance, many patients can only afford medical bills if they can pay for their expense over the long term and through a payment plan.  “Providers should consider patient financing because over time, it delivers better net collection,” Haupt said.

Read more...

Managing Patient Payments: A Balancing Act (Part 1)

A growing number of healthcare providers are considering how to reach patients as self-pay responsibility for their medical bills increases, including the option of offering patient loan financing programs at different stages of patient interaction.  The programs help providers lessen their financial burdens and lower bad debt.

Bruce Haupt, president and CEO at ClearBalance, a healthcare patient payment financing company, presented on Understanding Alternative Patient Financing Options at ACA International’s Fall Forum and Expo in Chicago. Healthcare providers use patient financing companies and often expect early-out collection agencies they work with to provide options as well.

“Offering patients an extended payment plan, such as the ClearBalance zero interest loan, doesn’t shift the burden of collecting bad debt,” Haupt said. “It’s really to provide a better patient payment option and give the health system a better collection rate overall.”  Patients’ financial obligations for their medical bills represent 18 percent of revenue for healthcare providers, according to recent research on patient pay from athenahealth.

High deductible health plans are becoming more prevalent today and with that patients’ financial responsibility for their healthcare also increases, even if their monthly premiums are lower.  According to athenahealth, the number of consumers in the U.S. with high-deductible health plans has increased 75 percent since 2010. More employers will offer only high-deductible health plans by 2018 and overall the popularity of the plans is pushing healthcare expenses out of reach for more and more consumers, according to athenahealth.

Providers offering patient financing options can tailor the programs based on their revenue cycle workflow and how they present the options to their patients.  “Revenue cycle leaders care very much about the patient and patient experience. We work with the provider to ensure financial counselors are trained in how to introduce the program.

Ultimately, offering a patient loan program is a value-add that creates loyalty and patient satisfaction,” Haupt said. 

More and more consumers consider their healthcare in terms of price and want estimates for the cost and options for how to pay for it within their budget, much like purchasing a vehicle or home. According to the ClearBalance

Healthcare Consumerism study 2016 results, 91 percent of respondents said healthcare is an expense that requires financing of more than 12 months.  One in three respondents said they would delay care if a financing option wasn’t available through their healthcare provider.

“Patient financing is absolutely intended to be a part of the hospital’s payment policies for patients,” Haupt said. “If you were considering going to a particular hospital for care or surgery, you’re probably going to want to know the cost. That’s what’s happening today with tools for price estimation, for example. People want to know what their cost will be.”

According to a 2016 Experian Health webinar “Providing Patients with Estimates: How Knowing What They Owe Can Boost Your Bottom Line” presented by product manager, price transparency, Elizabeth Serie, as consumers’ out-of-pocket healthcare expenses increase, price transparency information for patients is becoming critical for them to access at any time; allowing them to make educated decisions on how much they spend.

Technology can help patients and providers be on the same page with determining the best cost of care; and providers can implement standardized processes and best practices to communicate with patients, Serie explained during the webinar.  According to Serie, providing patients’ documentation in paper form in person or through mail or email after a visit can be a critical added step to ensure they can make an informed care decision.

And, providers can have a copy of that information readily available when the patient comes in for their scheduled care.  While price transparency continues to be a priority, providers or early-out collection agencies working with consumers on their behalf can discuss patient financing options at preregistration for care, time of service or after care to help ensure payment.  “My recommendation is to engage patients early in the process. Today there are lots of ways to do that,” Haupt said.

“A provider needs to think of patient financing as one component of their overall strategy to address the need to collect patient obligations and provide a good patient financial experience. It’s just a piece, but they need to be clear how it fits in their strategy.”

Read more...

How Will New Phone Technology Designed to Block Nuisance Calls Affect Provider Collection Efforts?

The second largest mobile cell phone provider, AT&T, has released a new service called “AT&T Call Protect.”  The press release issued concerning the free service says that it “gives eligible AT&T wireless customers…more control over unwanted calls on their smartphones.”  They also claim their service “harnesses the power of the AT&T network to give customers automatic fraud blocking and suspected spam call warnings.”

AT&T says that customers can sign up for this service through their account.  AT&T is also in the midst of releasing a new app “AT&T Call Protect;” an app that is designed to provide customers with the ability to block calls temporarily prior to reaching the customers phone and also gives “spam warnings” to customers regarding some incoming calls.

Senior VP of Device & Network Services Marketing, Jeff Bradley said “nuisance calls are an industry-wide problem that unfortunately affects many people.”  He also added “we’ve listened to our customers and know they want a network that provides tools to proactively assist in blocking nuisance calls.  AT&T Call Protect…will help put more customers in control of the calls they receive.”

This kind of technology does appear to be adverse for those working with accounts receivable; and will likely make it more difficult to contact patients if those contacting them have been identified as a “nuisance” (whether the identification comes from the patient themselves or by AT&T) no matter how legitimate and appropriate the call may actually be.  It’s worth noting that both Sprint and Charter Communications are already offering very similar products.

Those working specifically within the realm of healthcare collections will continue to receiving challenges in communicating with patients.  In fact, the reality is that such challenges will be even greater in the future as more communication companies equip consumers with the ability to block calls from specific, targeted telephone numbers.  Healthcare collectors will need to pay even greater attention to tracking data related to calling to decipher which numbers are and which no longer are effective.

Recently the Federal Communications Commission (FCC) has been looking at the issue of robocalls.  Robocalls are the top source of complaints; proving to be a plague to consumers according to the FCC.  Sadly though, legitimate business calls from medical collectors have been and will continue to be lumped together with illegitimate robocallers; creating a problem within the industry.

Tom Wheeler, the FCC Chairman will be stepping down in January which has the potential of changing the direction the FCC is moving when his replacement begins his or her tenure.  This change could ultimately affect the creation of federal policy regarding robocalls and the collection industry as a whole.  Many are hopeful that the collection industry will find a way to track data so as to create documentation regarding the impact of these new technologies.

Read more...

CMS Issues Online Quality Payment Program Tool

Healthcare clinicians now have access to a tool from the Centers for Medicare and Medicaid Services to “share automatically electronic data for the Medicare Quality Payment Program.”  The tool is part of the its ongoing projects “to spur the creation of innovative, customizable tools to reduce burden for clinicians, while also supporting high-quality care for patients,” according to a news release.

The CMS Quality Payment Program website was released in October. The tool, known as an Application Program Interface, “builds on that site by making it easier for other organizations to retrieve and maintain the Quality Payment Program’s measures and enable them to build applications for clinicians and their practices.”

In November, CMS reported tens of thousands of clinicians were using the tool.  “An important part of the Quality Payment Program is to make it easier and less expensive to participate, so clinicians may focus on seeing patients,” said Andy Slavitt, acting administrator of CMS.  “This first release is a step in that process, both for physicians and the technologists who support them.”

The Quality Payment Program is “modernizing Medicare to pay smarter for better care” through organized policy and improved technology and operations, according to CMS. “The Quality Payment Program is designed to reduce reporting burden on clinicians so that they can focus on their patients, while also providing useful information to clinicians and other stakeholders, so that overall care quality improves. As the program and its supporting website mature, CMS will continue to release data and APIs to spur innovation and keep participants up-to-date.” More information: http://ow.ly/wLGt306ShF4

Read more...

How Medical Bills Rank Among Other Sources of Consumer Debt

Paying off debt is the top cause of financial stress in the U.S., and GoBankingRates.com recently determined medical bills are among the sources of debt for consumers in addition to mortgages, student loans and credit cards. GoBankingRates.com conducted a survey on financial stress earlier this year, finding that paying off debt is the top cause of that stress among more than 7,000 respondents. It followed that survey by interviewing nearly 3,000 consumers on the type of debt they have and their loan balances.

A majority of respondents, 51 percent, said they are not in debt.  “Perhaps this is because some respondents are overlooking certain types of debt they might have, such as small balance accounts or loans in deferment,” said Bruce McClary, vice president of public relations and external affairs for the National Foundation for Credit Counseling in an article from GoBankingRates.com.

Only about 6 percent of respondents said medical bills are the biggest source of their debt, according to the survey. The median amount of medical debt for those respondents is $600.  “Although 79 percent of survey respondents report having zero medical debt, it’s the top source of debt in more states than credit card debt,” GoBankingRates.com reports.

The median medical debt for respondents earning up to $24,999 is $1,500. Twenty-seven percent of respondents in that income group have medical debt, according to the survey.  A separate survey on financial burdens, released by GoBankingRates.com in April 2016, found that healthcare costs are “the most worrying economic issue” for consumers.

The survey also found that many respondents reported carrying various forms of debt that varies depending on their income and age.  Among all respondents, consumers ages 65 and older are the least likely to have debt, while those ages 35 to 44 are the most likely to have unpaid bills, according to the survey.  Respondents who earn between $100,000 and $149,999 are more likely to have debt than respondents in other income groups.

More information: http://ow.ly/HNrJ305pPPX and http://ow.ly/2bGA305q2ap

 

Read more...

Best Practices to Improve Price Transparency

When Elizabeth Serie’s son broke his femur last year their experience in the emergency room shed light on the shortcomings of the process for patients to find cost information from a healthcare provider – especially on short notice.  It’s important for patients to know the cost of care at the time of service and the discussion of price transparency best practices is becoming commonplace among healthcare providers today.

Serie is familiar with this trend primarily through her career as product manager, price transparency, for Experian Health, but said her experience in the emergency room exemplified how little information is available on cost of care.  “Within a few minutes I was able to learn more about [my son’s] injury and treatment online—in between conversations with doctors—but I could find little about the cost,” Serie said.

As consumers’ out-of-pocket healthcare expenses increase, price transparency information for patients is becoming critical for them to access at any time; allowing them to make educated decisions on how much they spend.  Serie presented trends and best practices on price transparency for healthcare providers during a recent Experian Health webinar “Providing Patients with Estimates: How Knowing What They Owe Can Boost Your Bottom Line.”

Today, consumers have many more options for their care and have to be mindful of cost if they are enrolled in high deductible health plans— which can lead to higher out-of-pocket costs.  Discussion of price transparency is also increasing at the legislative level and some states are considering legislation against “surprise medical bills,” according to Serie.  

“Surprise medical bill is a term commonly used to describe charges arising when an insured individual inadvertently receives care from an out-of-network provider, according to a report from the Kaiser Family Foundation released in March 2016.  Technology can help patients and providers be on the same page with determining the best cost of care; and providers can implement standardized processes and best practices to communicate with patients, Serie explained during the webinar.

Providers should also train staff on consistent processes and consider having a script for employees to follow as they speak with patients. This can help providers have the information they need to collect payment from consumers in a timely manner and for patients to know they have accurate in-network price estimates before they receive care.

“Incorrect registrations are major financial burdens for any kind of facility, especially when employees must designate time to work the denials and reconcile any incorrect reimbursement,” Serie said.

The bottom line, according to Serie, is for providers to determine what it will take to acquire the consumer who will be able to pay a portion of their bill or leverage available financial assistance.  “My answer is pretty simple, have the best processes and tools in place to make sure the staff is satisfied and that transfers to patient satisfaction and higher collections prior to service,” Serie said.  

According to Serie, providing patients’ documentation in paper form in person or through mail or email after a visit can be a critical added step to ensure they can make an informed care decision.  And, providers can have a copy of that information readily available when the patient comes in for their scheduled care.  A price transparency tool that patients can access themselves online could also be a win-win in the long run.

“If we can continue to get good at providing estimates, we’re also going to want consumers to be able to take some of that pressure and responsibility off of us and have them to be able to get the information on their own,” Serie said.  At the same time, they expect clarity and functionality at their healthcare provider’s office that will provide a seamless encounter between accessing information online and in person.

Through technology and in-person assistance, patients will eventually be able to research their symptoms, find the right provider for their specific care, get a price estimate, schedule an appointment, receive care, manage accounts and pay for service, conduct follow up and obtain feedback, according to Serie during the webinar.  

“During this online healthcare encounter, it’s truly an opportunity to engage the patient. The consumer is introduced to you and your brand at this time. They’re really seeking information; they want it to be super quick and easy.  Reinforce that positive experience and your brand and build that confidence, trust and loyalty with your patient,” Serie said.

Visit Experian’s website to listen to an archived recording of the webinar: http://ow.ly/f6Nc304Q6Nw.

Read more...

HHS ‘A Bill You Can Understand’ Challenge is Underway

The Centers for Medicare and Medicaid Services has proposed changes to the Physician Fee Schedule to update how Medicare pays for primary care.  “The rule’s primary care proposals improve how Medicare pays for services provided by primary care physicians and other practitioners for patients with multiple chronic conditions, mental and behavioral health issues, as well as cognitive impairment or mobility-related impairments,” it states. “These changes will improve payment for clinicians who are making investments of time and resources to provide more coordinated and patient-centered care.”

Updates to payment policies, payment rates and quality provisions for services provided in calendar year 2017 are included in the annual Physician Fee Schedule.  “Today’s proposals are intended to give a significant lift to the practice of primary care and to boost the time a physician can spend with their patients listening, advising and coordinating their care—both for physical and mental health,” said CMS Acting Administrator Andy Slavitt in the news release.

Additional policies proposed in the 2017 payment rule include primary care and care coordination, mental and behavioral health, cognitive impairment care assessment and planning and care for patients with mobility-related impairments.  “The rule proposes revisions to payment for chronic care management, including payment for new codes and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions,” according to CMS.

“This proposed change is a significant update to the Physician Fee Schedule and will support primary care when and where patients need it most.”  CMS is accepting comments on the proposed rule until Sept. 6 and will respond to comments in a final rule.

More information: http://ow.ly/jGhN302rp4R.  Download the proposed rule from the July 15, 2016 Federal Register at https://www.federalregister.gov/publicinspection.

 

Read more...

ACA Exchanges Receive Enough Revision to Continue

 

The changes that have been put forth to help secure the Affordable Care Act (ACA) exchange markets for health insurance consumers should be enough to tide it over for another year but it is likely that more changes will be necessary in the upcoming year.  The change announcement has been released sooner than originally planned and it includes adjustments to plan year 2018 for plan requirements as well as the ACA risk adjustment program.

These revisions were brought on due to the fact that major insurers on the exchanges such as UnitedHealth, Aetna and Humana have all said that they would be scaling back their offerings in plan year 2017 which has created issues.  In fact, these issues coupled with low enrollment in the exchanges has forced some to question whether the exchanges have the ability to continue.

Some have voiced concerns about noteworthy premium increases in certain states, even as the Department of Health and Human Services (HHS) released their findings which pointed out that coverage in these States would still be affordable for those receiving premium subsidies.  

The changes are being met with optimism by those in the health insurance industry and many are pleased that recommendations by the industry are being addressed in those latest changes.  It is likely that smaller, more regional plans having less capital on hand will be most benefitted.  

Changes to risk adjustment have become vital as the insurance industry has pointed out that those enrolling in plans have proven to be sicker and thus more costly to insure than first expected.  A new factor being taken into consideration is prescription drug data for diseases such diabetes, AIDS and HIV or Hepatitis C.

It is a certainty that risk adjustment will be paying close attention to those who enroll through the exchanges outside of the open enrollment window.  Some insurers have stated that consumers have been waiting until they are sick and in need of care to sign up for health insurance.  Restrictions for enrollment outside of the open enrollment period have become stricter in response to industry concerns.

While the Obama administration is working to instill confidence in the health insurance marketplace so as to leave a stabilized market; the next administration along with the Congress are likely to make changes to keep the system in place.  

Other changes that have given a level of hope and encouragement are the fact that healthier and younger people are enrolling which will provide them the option of less coverage for a lower premium each month.  

CMS is also considering a Simple Choice plan that would work as a high deductible plan that can be used in conjunction with a health savings account (HSA).  This would be a bronze level plan and come as a choice in response to the need for high deductible options as they are “valued by many consumers.”

Bronze plans require the consumer to pay for a major service before the deductible kicks in; a service such as an emergency room visit, a doctor’s office visit, or a drug purchase.  Preventative services, however, will still require no out-of-pocket expense from the insured.

While it is extremely important that the younger and healthier group of consumers become a part of the health insurance system, some of the new options are of concern to patient advocacy groups.  They fear that some consumers might not fully understand which services are and which are not covered and thus will not fully understand how a high deductible insurance policy works.

Read more...
Subscribe to this RSS feed