Managed Care Contracting & Provider Payment

Some Thoughts About Financial Hardship Waivers

Providers have maintained financial hardship policies for decades.  Typically, a provider establishes a process for determining which patients qualify for its charity care program.  What’s new about this?

This process used to be primarily for uninsured patients.  However, in light of the increased enrollment in high deductible health plans and reductions in insurance benefits (i.e., capped and limited services, increased co-payments), more and more underinsured patients are asking for financial hardship waivers.  See earlier posts on HDHP and Underinsurance HERE and HERE.  What had been a process exclusively between patient and provider now can have ramifications with the payor.  Can you grant a patient’s request for a hardship waiver without jeopardizing your payment from the insurer or self insured payor? 

Another Useful Tool to Collect Deductibles

I have been writing for a while about approaches to collect deductibles from patients.  See for example, earlier Post.

Yesterday, InsureBlog pointed out another tool that may be of interest when attempting to collect from a patient enrolled in a high deductible plan.  I remember speaking about this at an association of specialty hospitals and seeing the CFOs sit up and start taking notes.

Price Estimates and Informed Consumers

I received a call from a hospital describing an increasingly common scenario:  a potential patient calls asking for the price of an outpatient CT scan; either because he is uninsured or is covered by insurance with a deductible.  The caller had already called several other providers and this hospital’s price was higher.  Even if the caller was covered by a high deductible plan (and was therefore entitled to pay the insurer’s negotiated rate) the hospital’s charge for the scan was still higher than the competitors’ prices – especially outpatient scanning sites.

The hospital wanted to know whether it could match their “competitor’s” price for the MRI.

2009 Health Savings Accounts Limits Published

The IRS Published its updated limits for High Deductible Health Plans and Health Savings Accounts in 2009:

Annual Contribution Limit (maximum allowable deduction) to Health Savings Account
$  3,000 for individual coverage
$  5,950 for family coverage

Minimum deductible for High Deductible Health Plan:
$  1,150 for individual coverage
$  2,300 for family coverage

Maximum out of pocket spending limit
$  5,800 for individual coverage
$11,600 for family coverage

Link to IRS Revenue Procedure 2008-29

New GAO Report Confirms Failure to Fund Deductibles, Offers Hope

A recent report issued by the General Accounting Office on May 14^th underscores how high deductible health plans (HDHPs) present payment issues for patients and consequently, collection issues for providers. 

HDHP and Underinsurance

A study, published 4/15/08 by the Kaiser Family Foundation showed that those uninsured whom the proponents of high deductible health plans (“HDHPs”) hoped would buy HDHPs, don’t have the assets necessary to pay the deductible. According to the report-

Maximizing Collection of Deductibles – 10 Thoughts

Although we’ve heard a lot about covering the uninsured lately, another equally valid concern is the problem of the underinsured. Underinsured patients have some coverage, but the coverage is insufficient to meet their medical needs and financial obligations. Patients who are covered by an insurance policy with a deductible but without the means to pay for it are among the underinsured.

What steps can a provider take to minimize the risk that it will be unable to collect a patient’s deductible – either at the time of service or later?

Some Considerations when a Payor Offers “Real Time Claim Adjudication”

As I’ve said in previous posts, providers should consider giving their best rates only to those payors and products that yield the highest return – defined as some combination of paying high rates and imposing few administrative hassles. See previous post: Here.

This is certainly true when the payor is offering – or may begin to offer – high deductible health plans.  I’ve been reading lately about payors offering Real Time Claim Adjudication (“RTCA”) as a way to allow accurate collection of a patient's deductible at the time of service.   See earlier post about Aetna. Humana recently touted their RTCA system as saving their “pilot practice” $14,000 per year in billing costs.

New Hampshire Department of Insurance Issues Position on Collecting of Up Front Deductibles

On April 4^th, the New Hampshire Department of Insurance issued a Bulletin stating that providers of service cannot collect a deductible from a patient in advance of service unless they have actual knowledge that the patient has not met his / her deductible.

New Hampshire: Can you Collect that Consumer Directed Health Plan Deductible Up Front?

There are a “plethora” of articles encouraging providers to implement “up front” collection techniques to save billing expense, increase cash flow and take advantage of the provider’s best opportunity to collect. Given the increase in insurance offerings featuring high deductibles, you will want to be able, whenever possible, to collect your deductible at the time of service. Some payors offering high deductible health plans (“HDHP”) offer tools that will allow you to verify whether the deductible has been met in “real time”. Others have language that expressly prohibits you from collecting the deductible until the payor provides you with an EOB stating the amount due from the patient. You will also need to look to your state laws.