A billing association survey reveals the top HSA troubles If your practice is trying to overcome the potential negative effects of health savings accounts (HSAs), rest assured -- you-re not alone. The proof is in the results of a poll the American Medical Billing Association (AMBA) ran with its members. Take a look at how HSAs affect the 100 survey respondents. The question: How have high-deductible health plans (HDHPs) and/or HSAs affected your provider's income in 2008? Responses: - Patients with those types of plans are not coming in to see the provider as often -- 18 percent - We are looking for ways to better deal with these types of health plans -- 15 percent - We-re sending more and more of those patients to collections -- 13 percent - Patients are paying at the time of service -- 10 percent - Patients are not paying at the time of service but within a reasonable time -- 10 percent - We have noticed a median decrease in income from these types of patients -- 9 percent - None of the above applies to my providers -- 8 percent - We have noticed a huge decrease in income from these types of patients -- 7 percent - We have only noticed a slight decrease in income from these types of patients -- 4 percent - My providers have implemented a new process such as automatic checking or automatic debit/credit card services to alleviate this problem -- 4 percent - We have not noticed a decline in income from these types of plans at all -- 2 percent. -- Source: An e-mail poll by AMBA, provided by Cyndee Weston, executive director of the American Medical Billing Association in Sulphur, Okla.