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News & Notes

CMS: The Impact of Cost on Health Coverage

Recent reports from the Centers for Medicare and Medicaid Services show health insurance enrollment trends, including the impact of healthcare cost and affordability on consumers.  The Effectuated Enrollment report shows nearly two million people, after selecting a plan through health insurance exchanges, did not pay their health insurance premium to maintain health coverage in early 2017, citing cost as the primary reason. Read more here:


Study: Who is at Risk for High Out-of-Pocket Costs

A growing number of consumers with employer-sponsored health insurance and their families are paying more out-of-pocket for healthcare, according to Kaiser Family Foundation research. For example, nearly 25 percent of workers spent $1,000 or more on healthcare services and more than 1 in 10 spent over $2,000 in 2015.  “This represents a growing fraction of patients over the last decade, with the share spending $1,000 or more rising from 17 % to 24 %.”


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Pulse is published for ACA healthcare collection agencies to provide current industry information for healthcare providers. ACA International welcomes article ideas and submissions for consideration in Pulse. Ideas may be submitted to ACA’s Communications Department at


Healthcare Organizations Lack Focus on Cybersecurity as Risks Continue

Healthcare provider organizations are lacking in planning and leadership for cybersecurity programs, according to results from a fourth quarter 2017 survey conducted by Black Book Research.  More than eight in 10 provider organizations surveyed do not have a “reliable enterprise leader” for their cybersecurity programs, according to a news release from Black Book™.

Results from payers, however, show more interest in cybersecurity planning.  “When it comes to payers, 31 percent have an established manager for cybersecurity programs currently, with 44 percent planning to recruit a candidate in the new year,” according to the news release.  However, Black Book™ also reports the healthcare industry is underestimating security threats and organizations are hesitant to adopt best practices for cybersecurity.

Fifty-four percent of respondents revealed they do not conduct regular risk assessments and 39 percent said they don’t test their security firewalls on a regular basis.  “The low security posture of most healthcare organizations may prove a target demographic for which these attacks are successful,” Doug Brown, managing partner of Black Book™ said in the news release.

This lack of planning is concerning given that the healthcare industry is one of the top targets for data breaches recently. Among the larger-scale healthcare security incidents in 2017 (, a Verizon data breach in 2017 resulted in the release of a private database affecting 14 million customers; and patient data, including their name, Medicaid ID number and more, for 1.1 million people was inadvertently made public through a live hyperlink in an Indiana Health Coverage Program Report.

Findings from the November 2017 Protenus Data Breach Report ( show there was at least one healthcare data breach per day since the beginning of 2017.  The U.S. Department of Health and Human Services (HHS) Office for Civil Rights continues to monitor the issue of cybersecurity in healthcare and stresses data breaches caused by insider threats are a recurring issue. (

Cybersecurity tips from HHS include:

Consider using logs to document whenever access is granted (both physical and electronic), privileges increased, and equipment given to individuals.

Consider having alerts in place to notify the proper department when an account has not been used for a specified number of days.

De-activate or delete user accounts, including disabling or changing user IDs and passwords. “When an employee or other workforce member leaves, it is extremely important that coveredentities and business associates prevent unauthorized access to protected health information (PHI) by ensuring that the former workforce member’s access to PHI is effectively terminated,”HHS reports.

ACA International will host its two-part Data Security and Privacy seminar, including tips for implementing effective policies and procedures, in March. Visit our Events calendar for more details and to register. https://www.acainternational.


3 Tips to Improve the Patient Experience at Your Facility

When it comes to getting healthcare services today, patients are behaving more like consumers than ever before. Patients are now faced with many options; such as where to get treatment or their next surgery. Just like choosing a smartphone, patients shop around, perform their own research, and ask for referrals from friends or family before they go for healthcare services. This is why the patient experience is playing such a critical role in a healthcare facility’s bottom line.

Rising healthcare costs and out-of-pocket expenses due to high-deductible health plans have contributed to this healthcare consumerism trend. Patients are now the new payers. In this digital age, patients are researching their options online to find the best solutions for their circumstance. This is especially true for outpatient elective or non-emergency surgical procedures in ASCs. To stay competitive, improving the patient experience is critical. Here are 3 tips for a world-class patient experience: 

1. First Impressions and Waiting Times

Data from a recent survey of 200,000 patients conducted by Athena health revealed that the longer the waiting time before patients meet their provider during a first appointment, the less likely that patients would recommend the practice to their friends.

82 percent of patients who waited for just 0 - 5 minutes during a first appointment were likely to recommend the practice to their friends; while just 47 percent of patients would recommend the practice if they waited for 45 or more minutes. 

2. Compassion and the Human Touch

Today’s age of technology and artificial intelligence are now playing a greater role in healthcare, but compassion and the human touch is still the most important principle. Both patients and doctors rank compassion as the most important element in healthcare.

A survey by HealthTap revealed that 89 percent of physicians cited compassion as a very important part of delivering the best care (even higher importance than education and command of medical knowledge) and 85 percent of patients said compassion was very important (even higher importance than cost and wait times). Additionally, 94 percent of doctors stated that being compassionate makes their patients more likely to follow their advice.    

3. Patient Financing

With ballooning out-of-pocket expenses, co-pays, and coinsurance, comes the rise of predatory subprime lending programs designed to lure patients who find themselves in financial distress. It is critical that providers are educated about the lending they are introducing to their patients if they want patients to come back for care or to refer friends and family. Healthcare providers, particularly ASCs and physician practices, rely on referrals and repeat business to stay competitive. It is critical today to find a partner for your facility that would offer patient financing options at zero or very low interest rates. 


Technology, Price Transparency are Critical to Meeting Patient Demands

Patients want more options when it comes to healthcare financing, engagement with providers and price transparency, according to results from the Black Book2017 Revenue Cycle Management surveys.  The surveys are the result of a research study “designed to trend consumer satisfaction and patient experiences, as well as uncover payment challenges and strategies for provider organizations,” according to a news release.

Black Bookpolled both patients and providers in the second and third quarter 2017 with consumer surveys designed to determine how patient responsibility for medical bills, which has increasingly shifted from employers to patients, is impacting providers’ revenue cycles. The surveys included 2,698 healthcare providers and 850 consumers with high deductible health insurance plans.

Eighty-three percent of providers surveyed plan to address the increase in “patient consumerism” by offering more “retail-like technology solutions and practices.”  “Emerging healthcare pay trends reveal the opportunity to help patients better anticipate, manage and track the costs of their care,” Doug Brown, managing partner of Black Booksaid in the news release. “Innovative patient-friendly payment solutions that meet consumer preferences and enable fast transactions are playing a key role in this transition.”

Since 2015, according to Black Book’sfindings, patients experienced a 29.4 percent jump in their deductibles and out-of-pocket costs. The average deductible for consumers in 2017 was $1,820 and out-of-pocket costs increased to more than $4,400.  With consumers’ increased costs and rising unpaid medical bills, healthcare providers are turning to new strategies and technologies to recover those funds.

“Survey findings from 1,595 physician practices, 202 hospitals and 49 health systems reveal profit margins continue to be impacted negatively by traditional collection solutions, steering 82 percent of medical providers and 92 percent of hospitals to jettison time-intensive, error-prone, manual efforts to back end process and reconcile bills by Q4 2018,” according to the news release.

The surveys also show consumers prefer to pay their bills online. In the first half of 2017, nearly 62 percent of medical bills were paid online and 95 percent of those surveyed said they would use that option if available from their healthcare provider, according to the news release.  “Employing these solutions at the front end of the revenue cycle has given patient risk to providers and the attention has turned to establishing funding mechanisms to benefit not only the hospital or physician, but the consumer,” Brown said.  “Patients truly are the new payers.”

Additional key findings in the surveys include:

*Eighty-nine percent of provider financial administrators expect that healthcare payments will be made on phones and mobile devices by the fourth quarter 2018, however only 20 percent have the systems in place for electronic payments.

*Eighty-three percent of offices with under five physicians report “the slow payment of high-deductible plan patients are their top collection challenge, followed by the difficulties that practice staff have at communicating patient payment accountability (81 percent).”

*Patient payment services in high demand, according to healthcare providers, are transparency via cost estimation, managing consumer expectations through insurance eligibility verification before an appointment and enhancements to make payments more convenient for patients.

More information: and


Texas Law Expands Protections for Medical Account Mediation

The New Year rings in new protections for certain medical claims. Last year, Texas Governor Greg Abbott signed legislation to expand the existing law dealing with balance billing, which occurs when patients are directly billed by a provider for the portion of medical expenses not covered by their insurance.

This can happen when insured patients receive out-of-network care, often in an emergency care situation or when a patient is admitted to an in-network facility, but receives treatment from an out-of-network provider.  Texas developed a mediation system back in 2009 to assist consumers in resolving certain balance bills and made improvements to the system in 2015, and most recently again in 2017.

The most recent legislation, which applies to claims incurred after Jan. 1, 2018, broadens the types of accounts that are eligible for mediation protections already used by insured consumers in Texas on a limited basis. The newest law expands access to mediation eligibility to all out-of-network providers treating patients at in-network hospitals and other facilities.

Before the latest revisions, the existing law made mediation available to consumers who were balance billed by only six types of facility-based providers: radiologists, anesthesiologists, pathologists, emergency department physicians, neonatologists and assistant surgeons. The law also provides for mediation of balance bills for emergency care from any provider or facility of emergency services care, including freestanding emergency rooms.

In an effort to bolster awareness of the mediation program, the new law also institutes a new disclosure requirement to inform consumers of their mediation rights. Healthcare providers and other facilities must include a statement substantially similar to the following: “You may be able to reduce some of your out-of-pocket costs for an out-of-network medical or health care claim that is eligible for mediation by contacting the Texas Department of Insurance at [website] and [phone number]” on bills that are eligible for mediation. The disclosure must be in at least 10-point boldface type.

Healthcare and emergency services providers should make sure they are familiar with the new balance billing requirements that apply to certain healthcare claims incurred on or after Jan. 1, 2018, and determine how they will impact current billing practices.  Please note that the above-referenced legislation, S.B. 507, became law on Sept. 1, 2017, and applies to healthcare claims incurred after Jan. 1, 2018.


3 Best Practices to Improve Value-Based Care Reimbursement

The transition to a value-based reimbursement system from the more familiar fee-for-service (FFS) model has created an environment where providers are rewarded based on the quality of their service or the level of care delivered to patients. Practices will thus have to evolve in their strategies to be well positioned to bear greater financial risk while at the same time having to pursue improvements in quality. Here are 3 best practices that can help your practice improve reimbursements in a value-based care setting: 

1. Have a Clear Understanding of the Value-Based Reimbursement System

The first step towards a smooth transition to a value-based care payment model is to understand what value means; not just to your practice but to patients and payers. It’s important to understand that in a value-based world, payments are tied to outcomes, effectiveness, and efficiency. The aim is better care for individuals, improving population health management strategies, and reducing healthcare costs. How do you perceive improvement in service delivery? Is your perception of quality care aligned with that of patients and payers? Considerable effort should be made to align the measures of quality you adopt with that of patients and payers. Any form of misalignment should be identified and addressed.  

2. Make Actionable Data Available

A way to increase transparency in service delivery and gain the trust of patients and payers, which is vital to success in value-based care settings, is to make actionable data available on a regular basis. According to a report by the Alliance of Community Health Plans, data is “valuable only if actionable.” Publish data that captures improvements in service delivery by highlighting areas where value has been added and where significant reductions in cost have been achieved. This would build trust in patients and payers because they can easily evaluate the performance of a practice though the data provided.  

3. Educate Your Staff

The education of staff on how to engage with patients should be a top priority.  Operating in a value-based care setting demands that patient’s satisfaction should be pursued as payments are tied to it. According to Dr. Rita Numerof: “The satisfaction of the patient is going to be really important in outcomes. We’re going to have to look at quality outcomes.” Employees at all levels must therefore be adequately trained to understand patient’s needs and be well suited to meet them in the best way possible. 


News & Notes


How to Mitigate Risks from Mobile Devices

The use of mobile devices for communication is only growing, and in the healthcare space that means providers and their business partners must have airtight policies and procedures when it comes to processing consumers’ electronic protected health information (ePHI.) Mobile devices should be a part of a company’s risk analysis processes. More information:

Bankruptcy Filings on the Rise

Bankruptcy filings in the healthcare industry more than tripled in 2017, according to Bloomberg.  “Regulatory changes, technological advances and the rise of urgent-care centers have created a ‘perfect storm’ for healthcare companies,” David Neier, a partner in the New York office of law firm Winston & Strawn LLC, told Bloomberg.  Hospitals, including privately-owned facilities in rural areas, may be the most likely to file for bankruptcy after they were subject to reduced payments under The Affordable Care Act in the 2017 fiscal year.

We Want to Hear from You

Pulse is published for ACA healthcare collection agencies to provide current industry information for healthcare providers. ACA International welcomes article ideas and submissions for consideration in Pulse. Ideas may be submitted to ACA’s Communications Department at


4 Top Tips to Lower Your Claims Denial Rate

4 Top Tips to Lower Your Claims Denial Rate

In recent times, the claims denial rate of many practices has risen to unsustainable levels, soaring well above the industry standard of about 3-5%. The implications of high claims denial rates for a practice is far reaching as it hits at the core of revenue cycle performance; negatively affecting cash flow and dragging revenue growth. However, this does not have to be your center’s experience. Your practice can significantly reduce claims denial rates and witness a revitalization in revenue and cash flow growth. Here are 4 tips to help lower your denial rate: 

1. Analyze the Causes of Your Denials

The first step to take in reducing denials is to conduct an analysis of your present denial rate and identify the primary reasons for the denials experienced by your practice. While reasons for denials vary in each circumstance, it’s important that you discover the root causes of denials. You might want to look at your current processes, your staff, or your technology stack to get to the root cause. This is very crucial because adopting strategies of high performing practices might not result in any significant improvement in your denials rate if the root causes of denials are not identified and addressed.  

2. Minimize Coding Errors 

Errors in coding represent one of the greatest cause of claim denials for practices. Previous and newly developed codes must therefore be verified to ensure they are free from errors. To achieve this, a practice might have to employ the services of expert coders and billers if it lacks expertise to handle it in-house. Expert coders and billers will be a great addition to your staff as they will help fix coding and billing errors that cause loss of revenue.

3. Educate Your Staff

Education and training of your staff on effectively managing claims collection and denial processes should be given top priority by your practice. Many claims denials can be avoided if employees are trained on the best practices. Significant training should be given to employees to ensure accuracy of data collected from patients as this forms the foundation of a best-in-class claims management. 

4. Create a Claims Denial Unit 

Creating a unit specifically dedicated to claims denial management will help your practice reduce its denials rate significantly. Operational efficiency is easily achieved when a unit in your practice is saddled with the responsibility of identifying, resolving, and proffering solutions to the causes of claims denials unique to your organization. This team should comprise physicians, coders, billers, software development experts, medical researchers, and members of the top management.


News & Notes

Consumers’ Medical Debt Ranks Low Over Other Forms of Debt

GoBankingRates’ latest survey on debt in the U.S. shows what most of us already know – consumers have various debts of various sizes, the lowest being medical debt. Sixty-five percent of the 2,500 consumers surveyed have mortgage debt while 21 percent have medical debt. Among the respondents with medical debt, their balances are less than $500.

Family Premiums Under Employer Plans Continue Modest Increase

Yearly family premiums under employer-sponsored health insurance plans increased by $18,764 or an average of 3 percent in 2017, according to the 2017 Employer Health Benefits Survey from the Kaiser Family Foundation and Health Research & Educational Trust. And, employees’ average payment toward family premiums has increased at a faster rate than the employer’s portion since 2012.

Cybersecurity Plans are Difficult to Achieve

Complete protection against cybersecurity attacks for hospitals is a challenge, FierceHealthcare reports, based on research from Harvard University, Case Western Reserve University and Brown University in the Annals of Internal Medicine.  Hospitals are developing best practices in the aftermath of several significant cybersecurity attacks, but contingency plans are lagging in the U.S.


CMS: Medicare Premiums Will Decrease in 2018

Medicare coverage for beneficiaries of the program will improve in 2018, according to the Centers for Medicare and Medicaid Services (CMS.) This will result in more choices and options for Medicare coverage in 2018.  “As CMS releases the benefit and premium information for Medicare health and drug plans for the 2018 calendar year, the average monthly premium for a Medicare Advantage plan will decrease while enrollment in Medicare Advantage is projected to reach a new all-time high,” according to a news release.

CMS estimates that the Medicare Advantage average monthly premium will decrease by $1.91 (about 6 percent) in 2018, from an average of $31.91 in 2017 to $30. Seventy-seven percent of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium for 2018, it states.  “More affordable choices lead to greater health security for those who need it most,” Health and Human Services Secretary Tom Price said in the news release. “Both Medicare Advantage and Medicare Part D are providing a higher level of health security for so many of America’s seniors precisely because they are built to be more responsive to their needs.”

Medicare Advantage enrollment is estimated to increase to 20.4 million in 2018, a increase compared to 2017.  Thirty-four percent of consumers enrolled in Medicare are projected to be in a Medicare Advantage plan in 2018, according to the CMS news release.  “The success of Medicare Advantage and the prescription drug program demonstrates what a strong and transparent health market can do—increase quality while lowering costs,” CMS Administrator Seema Verma said.

“When Americans are empowered to choose the plans that fit their needs and the needs of their families, they demand more from their insurance plans and in turn plans, like any business, provide customers better service at a lower cost.  CMS also reports access to the Medicare Advantage program continues to be strong as 99 percent of consumers with Medicare also have access to a Medicare Advantage plan.  

“The number of Medicare Advantage plans available to individuals to choose from across the country is increasing from about 2,700 to more than 3,100–and more than 85 percent of people with Medicare will have access to 10 or more Medicare Advantage plans,” it reports.  “In addition, more Medicare Advantage enrollees are projected to have access to important supplemental benefits such as dental, vision, and hearing benefits.”

More information:


Healthcare Mergers & Acquisitions Strong in First Half of 2017

Revenue cycle management and healthcare IT mergers and acquisitions exceeded $14.7 billion in the first half of this year across 66 deals, according to the latest M&A Update from ACA International member company Greenberg Advisors, LLC.  “Transactions were completed in every corner of the market, large and small, and among technology and service companies alike. 

The activity mirrored the blistering pace set in the first half of 2016,” according to the report.  The latest data show that a majority of transactions in revenue cycle management and healthcare IT were under $25 million in enterprise value, but 30 percent of all transactions did exceed $50 million. This is a notable increase from the second half of 2016, when 18 percent of all transactions exceeded $50 million, according to the report.

Twenty-eight companies have made multiple acquisitions in revenue cycle management and healthcare IT since the beginning of 2016, it states.  “It is good to see the level of deal activity and interest in [accounts receivable management] rising again, creating more opportunities for owners and investors,” Brian Greenberg, CEO of Greenberg Advisors LLC, said in a news release. 

“A wide variety of buyers—from inside and outside of the ARM industry, from Europe and elsewhere—tell us that they are interested in making strategic acquisitions.” The findings for the first half of 2017 also show that 48 percent of sellers in accounts receivables management include firms focused on healthcare receivables or financial institutions.  Greenberg will be part of a panel of speakers at ACA International’s 2017 Fall Forum & Expo Nov. 1-3 at the Loews Chicago Hotel.

In “Dissecting the Deal,” scheduled for Nov. 3, Greenberg will join Harry Strausser III, Corporate Vanguard at Eastern Revenue Inc.; Michael Lamm, president/CEO of Corporate Advisory Solutions LLC; Michael Ginsberg, president/CEO of Kauklin Ginsberg Company; and Thomas Edens, president of Marion Financial Corp., will discuss how companies approach potential M&A transactions for buyers and sellers.

More information: and


Uninsured Rate on the Rise for Some Consumer Demographics

The uninsured rate for certain groups of consumers divided by their age, income and access to Medicaid, is on the rise, according to The Commonwealth Fund’s fifth annual survey tracking the Affordable Care Act.  There was a significant increase in the uninsured rate for consumers ages 35 to 49; adults earning more than 400 percent of the federal poverty level ($47,520 for one person and $97,200 for a family of four); and those residing in states that have not expanded Medicaid, according to a news release on the survey.

The Commonwealth Fund’s survey included a nationally representative sample of 4,813 adults ages 19 to 64 living in the U.S.  The uninsured rate for respondents ages 35 to 49 increased from 11 percent in 2016 to 15 percent in 2017, according to the survey.  The uninsured rate for adults with incomes at or above 400 percent of the federal poverty level increased from 2 percent in 2016 to 5 percent in 2017.  Consumers in this income group are responsible for the full insurance premium and are subject to annual premium increases, according to the survey.

Lastly, the uninsured rate for consumers living in states that did not expand Medicaid increased from 16 percent in 2016 to 19 percent in 2017.  However, “despite the uptick in uninsured rates for some groups, the overall rate remained statistically unchanged from 2016 at 14 percent, representing an estimated 27 million working-age adults nationwide,” The Commonwealth Fund reports.  “In the years since the Affordable Care Act was passed, more than 20 million Americans have gained health insurance,” said Sara Collins, vice president for Health Care Coverage and Access at The Commonwealth Fund and the report’s lead author, in the news release.

Expanding Medicaid in all states, making premium subsidies accessible to more consumers, and assisting them with finding coverage on the Affordable Care Act marketplaces could remediate limits on access to coverage for the uninsured, according to the survey.  Other findings in the survey include:

Subsidies help consumers with low incomes afford premiums. While about 64 percent of consumers with incomes below 250 percent of the federal poverty level reported their premiums “were very or somewhat easy to afford,” only 34 percent of consumers with incomes above those levels provided the same response.

Cost was the primary reason consumers did not enroll in a plan.  Seventy-four percent of uninsured adults who shopped the marketplaces and didn’t enroll in a plan or obtain other coverage reported they could not find a plan they could afford.  However, 66 percent of consumers who reported they didn’t enroll in a plan because they couldn’t afford it had incomes that meet the qualifications for premium subsidies or Medicaid.

In 2017, 57 percent of consumers enrolled in plans through the marketplaces are estimated to have coverage with cost-sharing reductions that lower their deductible, copayments and coinsurance.

More information:

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