Wednesday, October 26, 2011

Medicare Payment Advisory Commission to Impose Pay Cut For Medicare Providers

The Medicare Payment Advisory Commission is charged with supervising $500 billion in Medicare cuts as a part of the Patient Protection and Affordable Care Act.  In September of 2011, MedPAC proposed that specialists will receive a 6% cut in their fees per year for three years followed by a 7 year freeze without any adjustment for inflation; general practitioners will face a 10 year freeze on their reimbursement fees, with no adjustment for inflation.  Despite overwhelming opposition from Medicare patients, Medicare providers, and many Health Organizations, they have recently gone ahead and voted to impose these drastic pay cuts on all doctors that accept Medicare as of January 1, 2012.

These cuts and pay freezes will equate to a 50% real pay cut for specialists and a 30% real pay cut for general practitioners over the next 10 years.  This assumes that inflation stays at a very low 3%.  Obviously, higher inflation would make the cuts in real pay even more drastic.

Consequences of this decision:

1)  Many physicians, and most specialists, will refuse to treat patients with Medicare as their primary insurance.  There are certain costs that physicians assume by practicing medicine and treating patients.  These include the obvious business overhead expenses, such as: rent, utilities, malpractice insurance, medical supplies, salaries of employees/nurses, etc.  Why would a physician want to treat a Medicare patient when they know that the reimbursement for treating that patient may not cover their expenses?

2)  More medical care will be turned over to nurses, nurse practitioners, and physician assistants.  Few people will ever get to see a doctor under the Medicare program.

3)  Medicaid will follow suit and cut their reimbursement fees as well.

4)  Many commercial insurance companies will also follow suit and cut reimbursement fees.

5)  The quality of health care in America will be drastically impacted because many students will choose to pursue careers in other fields.  The cost of medical school plus interest on student loans is always increasing.  Decreased future earnings to pay back these loans will prevent attending medical school from being a viable option.

If we do not take a stand, these cuts will drastically impact the health care industry in the United States.  I encourage you to write your Congressional Representatives and U.S. Senate Representatives to make your voice heard.

Thursday, October 13, 2011

Maximizing Collection of Patient Debt

As a billing company, we are obligated to honor the patient collection policy of the practice and its physician owner/s.  Unfortunately, too often we encounter practices without written policy on this critical component of the practice income.  Front desk and billing staff need guidelines to follow.  It is imperative that the practice owner(s) be the one who establishes policy regarding patient responsible debts and then be consistent in support of the policy.  It is inevitable that patients are going to “forget their checkbook” or fail to inform the practice of a lapse or change in coverage.  However, at what point should the patient not be able to receive services if they have not paid their copay or deductible?  How many patient statements should be sent when the patient is not making any attempt to pay before the practice refuses to see the patient?  Unfortunately, most practices simply cannot afford to allow those patients to receive services without honoring the cost share associated with their health insurance contract.  Be sure to make every way to pay available to the patient.  Be sure to offer credit cards as a payment option.
To the best of your ability, the practice policy should be clear and give the staff the authority to enforce the policy.  Many staff members are uncomfortable asking for money and empathize with patients who perhaps are struggling financially.  The employees assigned to the front desk staff need to be willing to ask for the patient’s copay and should have accurate patient debt information readily available.  Staff can pull the patient aside and explain that as a participating provider, the practice has agreed to require patients to pay their cost share as defined in the insurance contract.  Failure to do so could result in being terminated as a participating provider.   Everyone empathizes with our patients who truly are struggling, but it should be the decision of the physician/owner to give away their money, not someone at the front desk who feels bad for the patient.
Consistency in the enforcement of cost share literally trains the patient population.  If your patients repeatedly come to appointments without bringing their check book or credit card and still receive treatment, they have the right to protest when all of the sudden payment is demanded.  Patients need to be gently trained by the front desk staff/practice manager that they are required pay whatever monies are due based on the insurance contract that “THEY” selected.  After all, the patient chose the insurance plan that they wanted, not the other way around.  Rules and procedures need to be put in place by the doctor and followed by the staff 100% of the time to prevent patients from finding a reason not to pay.  If there is confusion amongst staff members as to whether or not a copay is due, or whether or not the patient has had “Bad Debt Written Off” in the past, the patient isn’t likely to volunteer that information or offer payment while at the front desk today.

Procedures to increase patient collections:
1.       An eligibility report on each patient’s insurance should be run at the end of each day for the next day.  This will enable the staff to know exactly what copay is owed, before the first patient shows up at 8:00AM.
2.       Outstanding patient debt should be printed on the superbill or be readily available to the front desk staff.  If it does not appear on the superbill, at the end of each day, staff should look in the billing system to determine if there is a balance on the patient’s account.  If there have been more than two statements without payment, then the practice should designate an individual to meet with the patient prior to the physician encounter and review the unpaid balance.  If the patient cannot afford to pay the entire balance, then a payment plan can be set up.  The first installment needs to be due before the staff takes them back to see the doctor.
3.       Patients with a qualifying balance should receive a statement every month.  Patient statements should be sent out, from the billing office, at least 3 times per week. (We send patient statements EVERY DAY.)  This reduces the time between the patient receiving the EOB from their insurance company and receiving a patient statement from the practice.  It also evens out the number of phone calls from patients about their statement.  In order for this to be effective, the billing office must stay current with submitting charges and posting payments every day.
4.       Send patient a 2nd statement 30 days later.  We most often see practices send 3 statements prior to sending the 10-day collections notice.
5.       If there is no payment after the third statement, a 10 day collections notice should be sent to the patient.  The patient should also be called by the front desk staff to alert them of the forthcoming “10 day collections letter”.  Patients that have not made a payment or addressed the balance after the 3rd notice are unlikely to do so without something that catches his or her attention.  Some patients will respond before they are sent to collections.
6.       After the 3rd statement/ 10-day collections notice letter, account balances above a certain amount should be sent to a collection agency.  A note should be made in the patient’s chart that a balance was sent to collections.  The smaller balances, perhaps $50 and below, should be written off, and put in the patient’s chart.  The small balances can’t be forgotten about, even if the patient isn’t seen for an extended period of time.  Balances above $50 can be sent to collections.
It is vital to collecting patient debt that guidelines, like the ones listed above, are implemented and followed 100% of the time.  A practice teaches its patients that they do or do not have to pay cost shares.  Once a patient realizes that debt will eventually be written off, never to be heard of again, the likelihood of them honoring their cost shares diminishes demonstrably.  Unfortunately, being sent to collections may sever the relationship with that patient.  If we are consistent in asking for payment and respectful of those who are truly struggling, we have to ask ourselves how many non-paying patients can the practice afford to carry.  When we reach that point, having a patient leave is not always a bad thing.

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