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Pulse Magazine

Employer-Based Insurance Premiums Create Growing Burden for Families

  • February 27, 2019
  • Published in Billing



A growing number of consumers are doling out more of their paychecks for health care premium contributions through their employer insurance plans, according to The Commonwealth Fund Report “The Cost of Employer Insurance is a Growing Burden for Middle Income Families.”

“The cost of employer health insurance premiums and deductibles continues to outpace growth in workers’ wages. This is concerning because it may put both coverage and health care out of reach for people who need it most—people with low incomes and those with health problems,” said Sara Collins, lead author of the study and Commonwealth Fund vice president for health care coverage and access, in a news release.

“Policies that would reduce health care burdens on employees include fixing the Affordable Care Act’s family coverage glitch, requiring employers to exclude some services from the deductible and increasing the required minimum value of employer plans.”

Key findings from The Commonwealth Fund include:

In 2017, the average employee premium costs for single and family insurance plans totaled almost 7 percent of the median income in the U.S., compared to 5 percent in 2008.

Combined, the total expense from premiums for workers and “potential spending” on deductibles for single and family insurance plans increased to an annual amount of $7,240 in 2017. 

Employees’ contributions for insurance premiums also increased.  “Between 2016 and 2017, employee premium contributions rose by 6.8 percent to $1,415 for single-person plans and by 5.3 percent to $5,218 for family plans.”

See more information from the report here https://bit.ly/2PV28ah and in Data Watch.

Healthcare Providers Report Status of Revenue Cycle Management

Recent research shows some hospitals are lagging in implementing Revenue Cycle Management (RCM) solutions and consider outsourcing services only as a short-term solution.  “Twenty-six percent of all U.S. hospitals still do not have a viable, effective RCM solution in place, despite all the evidence of their positive impact on revenue, bottom line and efficiency,” according to a news release from Black Book Market Research LLC, which conducted the survey.

Respondents evaluated their technology services and solutions for the survey and of the “1,600 RCM modernization-delinquent hospitals,” according to the news release, 82 percent said they plan on making “value-based reimbursement decisions in 2019 without an advanced software implementation or outsourced partner.”

Results from a 2012 survey on RCM revealed that 35 percent of hospitals did not have an RCM strategy. The decline to 26 percent, “does indicate that there have been workable RCM IT plans adopted and new systems implemented by about 400 hospitals over the past six years.”

While a majority of respondents said they plan to implement advancement in RCM in-house, 85 percent also reported they would work with an outside firm for short-term direction, according to the news release.  

ACA International members interviewed for the January issue of Pulse said RCM is changing significantly based on technology and third-party agencies can provide valuable plan options to meet providers’ and patients’ needs.  (Read more industry insight on RCM in January issue of Pulse here https://www.acainternational.org/pulse.)

Additional findings from the Black Book Market Research Survey include:

Nearly 70 percent of providers said it takes a minimum of one month to collect a full balance from a patient.

They also seek to prevent claim denials through RCM.

However, challenges include staffing resources for RCM software and reimbursement.

More information: https://bit.ly/2T1UbSE

 

Billing Tree Survey Reveals Increase in Shift to Online Payments

  • January 31, 2019
  • Published in Billing

Online payments are catching up in the health care industry, where common payment methods continue to be on-site, mail and through live phone agents.  BillingTree, in results from its third annual Healthcare Operations and Technology Survey, reports 63 percent of providers offer web portal payments and more than 25 percent also offer options for text-based payment—a substantial increase over previous years’ findings.

Of note, providers’ responses show that plans to implement text-based payments surpass “Interactive Voice Response (IVR) automation.”  “The survey found the biggest payment pain-points facing health care providers for two consecutive years have been a patient’s inability to pay, collecting once the patient has left the facility, a lack of payment channels, compliance and issues related to insurance billing,” according to a news release from BillingTree, an ACA International affiliate member company in Phoenix.

However, the survey results also show payment options are changing to address these pain-points as well as patients who prefer having customer service and payment availability 24/7, according to the news release. “The BillingTree Healthcare Survey series continues to show a sector gravitating toward new payment technologies to improve revenue cycle management. 

This is evident in the continued strong adoption of web portals, IVR and now, for the first time, text-related payments—mirroring the overall mobile payment trend in the industry,” Pat McIntyre, BillingTree’s vice president of health care, said in the news release.  More information: https://bit.ly/2LvgltR

 

Senators Cosponsor Legislation to End Surprise Medical Bills; Lower Healthcare Costs

Two U.S. senators recently introduced companion legislation that would help consumers manage health care costs and stop unexpected medical bills. U.S. Sen. Jeanne Shaheen, D-N.H., introduced the Reducing Costs for Out-of-Network Services Act of 2018 in October to “combat escalating out-of-pocket healthcare costs for uninsured patients and for patients in the individual health insurance market who receive out-of-network care,” according to a news release.

Cosponsor U.S. Sen. Maggie Hassan, D-N.H., introduced companion legislation to help end surprise medical bills for consumers as a result of receiving care they didn’t realize was considered out-of-network. “Shaheen’s legislation protects patients who are uninsured or in the individual health insurance market, while Hassan’s legislation protects patients with employer-sponsored health plans,” according to the news release.

“The bills that Senator Hassan and I are introducing would help fix chronic problems in our health care system by lowering costs for patients and increasing access to health services,” Shaheen said.  Shaheen’s bill, would cap the amount that hospitals and physicians could charge uninsured patients and out-of-network patients who have individual market coverage, according to the news release.

The Reducing Costs for Out-of- Network Services Act, it states, would:

Significantly reduce out-of-pocket costs for patients who have individual market health insurance and receive care from out-of-network hospitals and physicians;

Substantially reduce out-of-pocket costs for uninsured patients who could otherwise be charged very high “full charge” prices for hospital and physician services; and 

Reduce premiums for individual market health plans by improving individual market insurers’ ability to hold down negotiated provider payments and costs for in-network care.

Shaheen is also cosponsoring Hassan’s legislation, the No More Surprise Medical Bills Act of 2018 that will help “protect patients with medical emergencies from surprise billing by prohibiting hospitals and providers from charging more than the in-network amount.”

Hospitals would also be required to notify patients in non-emergency situations if their services are is out-of-network and obtain their consent before providing care.  In November, Hassan highlighted the importance of her legislation during a hearing with the Senate Health, Education, Labor Pensions Committee focused on health care costs.

“Studies have shown that nearly 1 in 5 visits involves care from providers who are out-of-network, and non-emergency situations often result in surprise medical bills as well,” Hassan said.  More information: https://bit.ly/2PfE0yY

 

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