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Medicaid Enrollment Grows By 3 Million

Three million additional individuals enrolled in Medicaid or the Children’s Health Insurance Program through the end of February 2014 compared to the enrollment period before the Affordable Care Act Health Insurance Marketplace opened on Oct. 1, 2013, according to former Department of Health and Human Services Secretary Kathleen Sebelius shortly before her April 2014 resignation from the department.  “Enrollment in states that adopted the Medicaid coverage expansion increased five-fold compared to states that are not expanding Medicaid,” she said.

Across the 48 states that provided enrollment data for February 2014, states reported that approximately 62.3 million individuals were enrolled in Medicaid and CHIP.  Among states that adopted the Medicaid expansion and whose expansions were in effect in February 2014, Medicaid and CHIP enrollment rose by 8.3 percent compared to the July-September 2013 period. States that are not expanding Medicaid reported a 1.6 percent increase over the same period.

“Eligibility determinations also continued to grow,” Sebelius said.  “Between October 2013 and February 2014,

11.7 million people were determined eligible for Medicaid and CHIP by state agencies, up from 8.9 million reported last month for the October-January period.”  There is no deadline for states to expand Medicaid coverage. 

“Coverage for newly eligible adult beneficiaries is fully federally paid for under the Affordable Care Act for the first three years, and never less than 90 percent for the years following,” Sebelius said. “Expanding coverage reduces hospitals’ uncompensated care, lowers ’cost shifting’ to businesses that see higher health insurance premiums as some of the costs of caring for the uninsured are passed on to them, and strengthens local economies.”  More Information: http://bit.ly/1ka0GNu

Report: Fewer People Have Problems Paying Medical Bills

  • June 9, 2014
  • Published in Billing

The percentage of people having problems paying their medical bills is declining, according to an April 2014 report from the National Center for Health Statistics, which is part of the U.S. Centers for Disease Control and Prevention. Specifically, the percentage of people under age 65 who were in families having problems paying medical bills decreased from 21.7 percent (57.6 million) in the first six months of 2011 to 19.8 percent in the first six months of 2013. The report defines “family” as an individual or a group of two or more related people living in the same home.

“Almost 5 million fewer people than two and a half years ago are in families having problems paying medical bills,” said report co-author Robin Cohen, a statistician with the U.S. Centers for Disease Control and Prevention, in a HealthDay News article.  According to the report, the percentage of people under age 65 with private coverage who were in families having problems paying medical bills decreased from 15.7 percent in the first six months of 2011 to 14.1 percent in the first six months of 2013. For those with public health insurance, that rate decreased from 28 percent in the first six months of 2011 to 24.7 percent in the first six months of 2013. 

It also states that in the first six months of 2013, among people under age 65, 34.3 percent of those who were uninsured, 24.7 percent of those who had public coverage and 14.1 percent of those who had private coverage were in families having problems paying medical bills in the past 12 months.  More information: http://1.usa.gov/1ga1m4b

Medicare: Data Sheds Light on Medicare Payments to Physicians

As part of the Obama administration’s work to make the U.S. health care system more transparent, affordable and accountable, the Department of Health and Human Services has released new privacy protected data on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals. 

According to HHS, the new data also shows payment and submitted charges, or bills, for those services and procedures by provider.  It has details for more than 880,000 distinct health care providers who collectively received $77 billion in Medicare payments in 2012, under the Medicare Part-B Fee-For-Service program.

With the data, it will be possible to conduct a wide range of analyses that compare 6,000 different types of services and procedures provided, as well as payments received by individual health care providers.  Physicians and other health care professionals determine what they will charge for services and procedures provided to patients and these “charges” are the amount the physician or health care professional generally bills for the service or procedure.

“Data transparency is a key aspect of transformation of the health care delivery system,” said Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner.  “While there’s more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”  Kaiser Health News reports that the data release marks 35 years since a court issued gag order restricted anyone from sharing Medicare Part B payments to individual doctors.

“The uses of this data can and will go significantly beyond the identification of fraud, waste and abuse,” said Niall

Brennan, the Medicare official who oversaw the development of the database, in the article.  More information: http://go.cms.gov/1qITM2band http://bit.ly/1ex0enb.

Determining the Impact of Revenue Cycle Outsourcing

  • June 9, 2014
  • Published in Billing

Health care providers have several options when it comes to choosing revenue cycle services to outsource.  Experts in health care collections recently discussed the impact of full revenue cycle outsourcing during ACA International’s Spring Forum in March 2014.  Terry Armstrong, president of State Collection Service Inc., in Madison, Wis., moderated the session, which featured panelists Stephan Bernard, vice president of professional services for Connance Inc. in Waltham, Mass., and Gregory M. Snow, vice president of corporate solutions strategy for Conifer Health Solutions in Carmel, Ind. 

“When we talk about full outsource, this is the whole continuum of what happens in a revenue cycle from scheduling all the way through the admissions, discharge, medical records and then the billing and receivables,” Armstrong said.  Bernard discussed different pieces of the revenue cycle that a provider can choose to outsource, including scheduling, financial clearance, patient receivables management and coding. 

“You have to ask yourself the question, of these functions, which ones benefit from economies of scale [and] which ones are portable, meaning they can be centralized and possibly be moved off site,” he said. “Pretty much every hospital does outsource some component of revenue cycle management. Generally speaking, it will be highly specialized, such as charge reconciliation or clinical documentation or bad debt collections.

Most hospitals outsource bad debt collections.”  “In general it’s the question of, is this the direction the industry is going? To some extent I would say yes it is. Full service revenue cycle has established itself and it is here to stay,” Bernard said.  According to Bernard, hospitals elect to outsource services because:

• The most appropriate rationale for using full outsourcing is the core competency concept. Is the health care provider in business to manage a revenue cycle or is it just an ancillary function that frankly distracts from core competencies? For most hospitals, managing the revenue cycle is not a core competency.

• They know they need to update the revenue cycle, and they don’t have the capital to do it themselves. Using an investment partner is one of the key motivating factors in acknowledging that a revenue cycle has been left unattended for many years.

• It has come into a state of disrepair, and management has lost confidence in their ability to execute. Most often this occurs when new leadership comes into an organization, takes over, does an assessment of their own internal operations and feels they need to essentially bring in someone new who can really shake things up.

Snow addressed another aspect of revenue cycle management that can be outsourced—pre-service clearance.  “In the future, other than identification for security, the patient will be greeted and told the doctor will see them. It is to perform everything that needs to be performed … from an administrative point of view prior to the patient coming in for service,” he said. “What you’re attempting to do is make that visit 100 percent clinical in nature versus being half clinical and half administrative.”  The health care payment system is highly fragmented, inefficient and expensive to administer, Snow explained. 

“We’re looking at new payment models that are much more focused on quality, cost effectiveness and the patient experience,” he said.  Larger health care systems in one regional framework are the most interested in outsourcing revenue cycle management and viable for the process, according to Bernard.  “It’s a difficult model when you don’t have a sufficient scale and opportunity for centralization within any health system,” he said.

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