Podiatry Coding & Billing Alert

Heads up: Out-of-pocket revenue is a greater share of your practice revenue than ever before.

Are your billers complaining that they’re more overworked now than they were last year? Are your days in A/R climbing? Is revenue cycle management more challenging than ever before at your podiatry practice? You can thank the rise of high-deductible health plans (HDHP).

A 2016 National Center for Health Statistics (NCHS) report shows that 40 percent of privately insured people under 65 are enrolled in HDHPs. With the burden of payment increasingly falling on your patients, your billing and collection policies must adapt to compensate.

What is an HDHP?

A high-deductible health plan is a plan with a minimum deductible of $1,300 per year for self-only coverage and $2,600 for self-and-family coverage, as outlined by IRS prerequisites for a health savings account (HSA). The maximum amount out-of-pocket limit for HDHPs is $6,550 for self-only coverage and $13,100 for self-and-family coverage.

In theory, consumers in high-deductible plans make more cost-effective health decisions because they have financial skin in the game. The lower premiums appeal to those who rarely use health services (think Millennials) but must have coverage under the Affordable Care Act individual mandate.

Employers love them, especially as a means to meet the ACA employer mandate. Last year, one out of three companies offered HDHPs only to employees. That’s up from one in ten in 2010. Companies are attracted to paying the cheaper premiums, but also see reduced usage costs as employees avoid health visits, resulting in higher rates of hospitalization, to dodge the upfront costs, according to a 2014 Harvard Medical School study.

So what’s causing the problem? We can’t just blame The Man for this. Many people, particularly previously uninsured individuals using the marketplace, opt for HDHPs because of the lower premiums.

They just don’t understand what it is that they’re getting, according to a Journal of Economics study. Of those insured 25-to-64-year-olds surveyed, only 14 percent understood all four of the meanings of copay, deductible, coinsurance and out-of-pocket maximums.

And this presents two problem scenarios for your practice:

The patient who knows about how his plan works. Imagine a low-income patient has ignored a minor ailment to avoid paying for a visit. The minor problem then becomes a major one. This patient, who couldn’t afford treatment for his minor ailment, now has to come in for a more expensive major treatment. How will he pay this bill when he couldn’t pay the cheaper one?

The patient who doesn’t know how his plan works, only that he’s got insurance. This patient comes in for her appointment, flashes her insurance card, receives treatment, and then balks at the expensive bill that she thought insurance would pay. She wasn’t budgeting for a several-hundred-dollar visit. How will she pay?

Be proactive: No more “file-and-forget”

Your billing policy is more important than ever. Collecting on coinsurance and copays was time-consuming enough. Now, we’re talking about patients footing the bill for entire office visits up to these higher deductibles. Focusing on an efficient claims process is still critical, but proactive collection of dues plays a larger role than before.

• Ensure your patients are insured. The first step is to prevent denials. Verify coverage up front and train staff to question patients about their plan if you find issues. Check their eligibility information at every visit. 
  With Medicare patients it’s especially important to do this. You can check a patient’s eligibility through the MAC or via CMS’s interactive voice response (IVR) system at 1-800-MEDICARE.
• Confirm that your patients know how they’re insured. Most providers had a notoriously tough time collecting and processing patient payments before this recent shift. Now, your patients are not just responsible for more upfront costs: they may not even realize that their plan doesn’t cover their care until they see the bill. 
  To combat this, train your staff to discuss costs for copay and deductibles on appointment reminder calls. This guarantees patients are aware of their responsibility to pay on the day of care. Electronic subscription services allow you to verify the coinsurance and deductibles before the patient arrives.
• Collect balances on the front end. Collect coinsurance when the patient checks in at your practice, since these figures don’t depend on which services you render. Requesting payments before the appointment and immediately after dramatically increases collections and drastically decreases issues after treatment. It may help to discuss an amount to be paid at the point of care and establish a payment plan at that point, before it becomes an issue.

When dealing with Part B, you can generally bill the patient after treatment but before they leave your office. When checking out the patient, read the chart to determine what services the physician performed, then collect the appropriate coinsurance before the patient leaves the practice.

A changing healthcare landscape demands billing changes.

Research shows that after 90 days you have about a 70 percent chance of successfully collecting medical debt. With the ascension of HDHPs, fiscally challenged patients and patients who don’t understand their coverage are increasingly a cost of doing business.

In 2010, the NCHS study shows that 25 percent of insured people had HDHPs. 21 million more people have received insurance since then, and the demographic with greatest reduction in uninsured was poor people between 25 and 34.

Today, 40 percent of all privately insured individuals are covered by HDHPs. The growth of the insured population has gone hand-in-hand with HDHPs. And with the cost of healthcare predicted to outpace GDP growth through 2024, it’s looking like the trend will continue.

Note: to read the full NHCS insurance coverage report, please visit: www.cdc.gov/nchs/data/nhis/earlyrelease/insur201609.pdf.

To read the Harvard study on HDHPs leading to increased hospitalization, visit: http://content.healthaffairs.org/content/32/8/1398.abstract.