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Pulse Magazine

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News & Notes

Second Quarter Health Spending Growth Estimates Decline

Health spending growth estimates for the start of the second quarter 2017, show 4.5 percent growth year-over-year, compared to 5.2 percent for the first quarter and 5.2 percent for 2016, according to the “Altarum Institute Center for Sustainable Health Spending Health Sector Trend Report” released in July 2017.

http://ow.ly/pL0c30eec1Z

 

Consumers Report Favorable Interactions with Healthcare Providers

Consumers surveyed by the Pew Research Center report positive experiences with their healthcare providers, including 87 percent with a doctor visit in the last year who said their “concerns or descriptions of symptoms were carefully listened to.” Twenty-three percent said they “felt rushed by their healthcare provider.” 

http://ow.ly/u2ud30eeeaY

 

Report: U.S. Healthcare System Remains Behind Other Countries

The Commonwealth Fund’s latest research on the U.S. healthcare system shows while there has been “significant progress,” the U.S. still lags behind other countries. For example, 33 percent of U.S. adults in the survey reported they did not take a prescription medicine, visit a doctor when sick or receive recommended treatment in the last year because of the cost; compared to 7 percent in Germany and the United Kingdom and 8 percent in Sweden and the Netherlands.

http://ow.ly/RaMd30eefpU

Younger Generations More Likely to Avoid Healthcare Due to Cost

The impacts of possible changes, including repealing and replacing the Affordable Care Act, to healthcare legislation and services in the U.S. remain uncertain; but consumers are consistent in their concern about the cost of care, according to results from Bankrate’s recent Money Pulse survey.  Thirty-one percent of Millennials said they avoid medical care because of the cost, according to the survey of 1,002 adults in the U.S. conducted in May.

Twenty-five percent of Generation X, 23 percent of Baby Boomers and 8 percent of the Silent Generation in the survey said cost caused them to avoid medical care, Bankrate.com reports.  “It’s very concerning that people are forgoing medical attention because of the expense,” said Robin Saks Frankel, credit card analyst at Bankrate.com, in a news release. “Thirteen percent of respondents don’t have any health insurance at all—a risk that could cost them. 

Unexpected medical bills can lead to a huge financial burden that could take years to pay off should something go wrong.”  “Older millennials (ages 27-36) are most likely to forgo care due to cost … [and] about one in three Americans in that age group say they’ve chosen not to seek needed medical attention because they couldn’t afford it,” according to Bankrate.com.  

When asked how worried they are about access to affordable health insurance in the future, 35 percent of respondents said they are very worried; 21 percent said they are somewhat worried; 17 percent said they are not too worried; and 24 percent said they are not at all worried.  “That’s about the same level of concern we found when we asked the same question in August 2014, nearly a year after the opening of the health insurance exchanges created under former President Barack Obama’s healthcare overhaul,” Bankrate.com reports.

The survey also shows more than half (56 percent) of all respondents are concerned about health insurance coverage. Sixty-four percent of Generation X respondents said they are concerned about coverage; followed by 58 percent of Baby Boomers; and 56 percent of Millennials, according to Bankrate.com.  “That fear of the unknown is understandable, Tevi Troy, CEO of the American Health Policy Institute, told Bankrate.com. 

“But, he says coverage isn’t likely to change much for the estimated 177 million Americans who get health insurance through work. Employers are likely to continue providing affordable healthcare because it helps with recruitment, retention and employee morale—factors unrelated to any changes in government policy.”

More information:  http://ow.ly/9IEh30cOLsd and http://ow.ly/ixnA30dZvFJ

 

Medical Debt Reporting Requirements Take Effect in September: What You Need to Know

The National Consumer Assistance Plan (NCAP) has brought many changes to data furnishers, and there are more on the way, including in the healthcare collections field.  For a refresher, NCAP is the result of an agreement between the big three consumer reporting agencies (Experian, Equifax and TransUnion) and multiple state attorneys general.  The final result is a set of reforms that are reshaping, in many ways, how data is furnished to CRAs. 

While many of the NCAP reforms have already been implemented, a new round of reforms is set to take effect. Medical debt continues to be a huge market in the credit and collection industry. In 2013, healthcare-related

debt represented nearly 38 percent of debt collected through the third-party collection industry, according to the ACA International white paper, “The Role of Third Party Debt Collection in the U.S. Economy.”

 

Required by Sept. 15, 2017 for Debt Collectors and Debt Buyers

Do not report medical debt collection accounts (as defined by Creditor Classification Code 02) until they are at least 180 days past the date of first delinquency with the original creditor that led to the account being sold or place for collection.

Delete accounts that are being paid by insurance or were paid in full through insurance. This does not include accounts paid in full by the consumer. The date of first delinquency with the original creditor needs to be determined by the provider and furnisher based on the underlying financial agreements and the creditor’s policies for when an account becomes “delinquent.”

Date of delinquency, as defined in the Fair Credit Reporting Act, is “the month and year of the commencement of the delinquency on the account that immediately preceded collection activity, charge to provide or loss, or similar action.”

 

Practical Considerations

Now is the time to tackle these changes in order to make the transition smooth. Begin working with your operations personnel to update your policies and procedures and train your staff. Consult with other agencies that you may be in contact with to see how they are dealing with the new requirements. Educate clients on NCAP and work with them as you move forward. 

Most importantly, carefully review any information provided by the CRAs and contact the CRAs as soon as you have questions. The CRAs are the entities steering the implementation of the NCAP, so they are in the best position to provide clarification to furnishers.  

 

Andrew Pavlik formerly served as ACA International’s senior compliance analyst.

 

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

  • August 28, 2017
  • Published in Billing

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

 

 

 

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