No Surprise Act Tackles Unexpected Medical Bills

No Surprise Act Tackles Unexpected Medical Bills

New No Surprise Act Tackles Unexpected Medical Bills

Two-thirds of bankruptcies filed in the United States are a result of medical expenses. It’s an alarming statistic, but probably not surprising. It’s no secret that many people have trouble paying out-of-pocket medical costs, so much so that a recent survey from The Commonwealth Fund found that 72 million Americans have some sort of trouble with medical debt.

It’s a common problem, but why? Let’s say a person visits a hospital, perhaps an emergency room, and receives a myriad of services. Maybe they arrived via ambulance or required treatment from an anesthesiologist. Although they may inquire about an estimate at the time of service or have an idea of their coverage, the exact financial responsibility is often a mystery. But what’s a person to do? They need medical assistance, and they need it at that moment. Then a surprise arrives in the mail in the form of an outrageously high medical bill. It’s something many of us have likely experienced.

What’s the cause of such an expense? Often the charge stems from using an out-of-network provider. Basically, this means that the hospital may have been in-network, but the physicians were not. Additionally, patients are often confused about medical coverage. Even with a good understanding of their benefits, situations may arise that are out of their control, and there may be unintended outcomes. Patients may (falsely) believe that all services rendered will be considered in-network when they go to an in-network facility. However, this isn’t always the case. In some instances, even though their physician is in-network, patients referred to specialists (such as a pathologist or radiologist) may discover the ancillary services were out of network. It is only after the patient receives a bill that they discover the issue. In the case of an emergency visit, patients don’t have the luxury of researching for in-network hospitals and typically go to the nearest hospitals. Patients may also be taken to out-of-network hospitals by ambulance. Researchers estimate that 1 in 6 emergency room visits and inpatient stays involve care from at least one out-of-network provider. The cost of out-of-network visits can have devastating financial consequences for the patient.

2019 study by the Government Accountability Office (GAO) found that the cost for air ambulance services clocked in at approximately $40,000. A large portion of this cost (over 70 percent) often fell out-of-network, meaning that the balance usually was placed on the consumer. When such a service is needed, it’s understandable to not have the option to “shop around” for a cheaper, in-network alternative.

Thankfully, help is on the way. Leaders and policymakers at the federal level have taken steps to tackle the issue. On July 1, 2021, the Biden Administration announced a new rule aimed at protecting consumers from surprise medical bills. In conjunction with the Department of Health and Human Services (HHS), together with the Departments of Labor and Treasury and the Office of Personnel Management, debuted “Requirements Related to Surprise Billing; Part I.”

This announcement, the first in a series, will go into effect on January 1, 2022, and protect patients from those all-too-common surprise medical bills. It’s an important step forward in protecting patients.

“No patient should forgo care for fear of surprise billing,” stated HHS Secretary Xavier Becerra. “With this rule, Americans will get the assurance of no surprises.”

Let’s dive into the new regulation. Among other provisions, the rule:

    • Protects patients from surprise billing in emergency services. These provisions will safeguard patients in emergency care situations from unknowingly accepting out-of-network care and incurring unexpected expenses.
    • Limits out-of-network cost-sharing. Patient cost-sharing for emergency and non-emergency services, such as a deductible, cannot be higher than if provided by an in-network provider. Simply put, co-insurance or deductibles must be based on in-network rates.
    • Bans out-of-network charges for ancillary care. Previously, out-of-network providers like anesthesiologists could have been assigned, even though the facility or physician was in-network.
    • Requires that providers and facilities provide patients with accurate cost information and advance notice of any out-of-network charges for non-emergency services. A consumer notice must explain that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.
    • Allows providers and insurers access to a dispute resolution process should reimbursement issues arise around reimbursement.

With the increase in high deductible health plans and increased out-of-pocket costs, finances are top of mind. From the consumer’s standpoint, gaining healthcare services will be less stressful. On the simplest level, this ruling will hopefully eliminate those hefty surprise bills, which can only be seen as a positive. Moving forward, patients can rest assured that they will be more aware of expenses and will avoid out-of-network charges for emergency care.

So can consumers finally say goodbye to surprise medical bills? Hopefully, they become a thing of the past. And how will this bill affect the future of the industry? Advocates are hoping these regulations and newfound transparency will eventually lower costs, for one. More importantly, it shines a light on the need to improve the overall patient experience. It’s a step in the right direction and has the potential to improve healthcare policies going forward for years to come.

For more information on solutions that equip you to have informed conversations about financial responsibility and eligibility, contact a TriZetto Provider Solutions representative today.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

 

4 Strategies to Simplify Patient Payments

4 Strategies to Simplify Patient Payments

With healthcare costs on the rise and an increasing segment of uninsured consumers, the patient payment landscape is changing rapidly. How can medical offices evolve and optimize collections while keeping patient satisfaction high? Thankfully advancing technologies are making it easy to simplify collection processes to increase revenue.

1) Communicate responsibility

How many times have you purchased a good or service without knowing the cost beforehand? Probably not many. Healthcare should not be any different. By providing cost expectations, care providers can give patients the opportunity to not only understand their fiscal responsibility but to also take a proactive, involved approach. Communication allows patients to determine if the value of the service they are receiving is worth the cost. When finances and choices are transparent, patient satisfaction rises.

2) Collect upfront

It’s said that medical providers collect only 25 percent, on average, of available co-pays and deductibles at the time of service. If the patient departs after the initial visit without making a payment, the likelihood of receiving the co-pay drops significantly. Consumers are used to paying for a product at service at the time of use, so why should medical care be different? Capitalize on patients that are willing to pay at the time of service by collecting upfront. Processing payment during the appointment is a step toward helping the patient to be invested in their care, which increases the chance of gaining future payments.

3) Empower patients

We know that patients are taking a more active role in their care and like to be in control of costs. Knowledge is power, and giving patients the information and tools needed is critical to empowering patients to pay. An effective strategy engages the patient early to learn their payment and communication preferences, then proving the proper options.

4) Build awareness

When adding payment options or considering changes to your payment workflow, increasing awareness is key. Be sure to engage your staff and provide the most accurate information on your website and within advertising tools (such as posters in the waiting room). If time and budget allow, conduct a survey to gain patient feedback. A small sampling of users will give insight into the likelihood that patients will adopt new tools and practices. It’s critical to explain the value in an informative, yet simple to understand the way that will resonate with your audience.

Thinking your practice may not have the staff or means to optimize payment processes? Consider tools from TriZetto Provider Solutions that can enable patients to conveniently pay by utilizing a variety of methods, including easy-to-understand statements. Learn how our partnership can help you streamline your workflow, improve efficiencies, and get paid faster.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

Innovative Enhancements Can Maximize Revenue

Innovative Enhancements Can Maximize Revenue

We see it all the time, a patient visits their doctor’s office to seek treatment and then receives a bill in the mail for their portion of the medical expenses.  When a patient receives the bill, they are often alarmed at the amount that is due and may not have the funding to pay the balance in full.  In a recent study conducted by UCLA, it is estimated that there is $140 billion in medical debt that has been reported on credit reports (VeryWellHealth, 2021).  In fact, this research study found that one in every five consumers was already in collections prior to the COVID-19 pandemic.

As cases of COVID-19 increased in 2020, many consumers feared visiting their doctor’s office that they avoided their routine office visits, and/or lost their employment further impacting a patient’s ability to pay for any medical expenses.  As providers continued to keep their offices open, many providers witnessed a decrease in patient volume while also seeing a reduction in revenue.  According to a recent article published in Medical Economics (2021), 55% of practices were impacted by a decrease in revenue while 60% were impacted by a decrease in overall patient volume.  Combined with the number of patients that were already in medical debt and/or collections, many practices faced a financial crisis as a result of the COVID-19 pandemic.

As the COVID-19 pandemic seemed to become more stable in early 2021, many patients felt comfortable returning to visit their doctor and/or were able to secure employment, providing patients with employer-sponsored insurance coverage. With the current rise of COVID-19 cases increasing again, practices are left with the ongoing challenges of attempting to maximize revenue collection with the risk of history repeating itself and the patient’s inability to pay their medical bills or avoiding their office visits.

Contrary to belief, consumers actually want to pay their medical bills and are seeking more payment options.  According to the 2020 Trends in Healthcare Annual Report, providers and consumers must adapt to a new payment experience in order to enhance how they interact with one another. In addition, more than half of consumers would consider changing their provider for a better payment experience.  One may ask, what constitutes a better payment experience?  Consumers are showing a higher demand for contactless payments and the ability to work with their providers to create a payment plan or auto-payment options. Unfortunately, many providers have not adapted to their consumer’s needs and continue to operate with traditional methods creating dissatisfaction amongst their consumers

How can providers change their operations to facilitate a more consumer-friendly experience for their patients? Front-office staff play a pivotal role when interacting with patients and should be collecting up-to-date contact information to ensure patients are communicated with effectively, have the most recent insurance data to avoid any processing delays, and should collect a patient’s consent ahead of time for new features such as eBills, texting, and payment preferences.  EZ Claim customers can streamline their revenue collection opportunities by partnering with BillFlash for innovative billing opportunities and various payment collection features that consumers highly desire.  While nobody can predict if this recent wave of COVID-19 cases will lead to another quarantine phase or not, it is important for providers and consumers to enhance how they interact with one another to create solutions for healthcare needs.


For more information about automated patient statements and patient payment options, contact EZClaimNexTrust BillFlashGetPaid@BillFlash.com, or call BillFlash at 435.940.9123 (Option 3). For more details about EZClaim’s medical billing software, visit their websitee-mail their support team, or call them at 877.650.0904.


Resources

Hui, K. (2021).  Americans owe $140 billion in medical debt. Here’s how to avoid it.  Very Well Health. Retrieved from https://www.verywellhealth.com/medical-debt-medicaid-study-5194846

InstaMed (2021).  The Trends in Healthcare Payments (11th Annual Report) 2020.  Retrieved from https://www.instamed.com/white-papers/trends-in-healthcare-payments-annual-report/

Luz, M. (2021).  How an effective revenue cycle management strategy can help reduce burnout.  Medical Economics.  Retrieved from https://www.medicaleconomics.com/view/how-an-effective-revenue-cycle-management-strategy-can-help-reduce-burnout

 

HIPAA Training Standards Businesses Need to Know

HIPAA Training Standards Businesses Need to Know

Per the HIPAA Privacy Rule and HIPAA Security Rule, both Covered Entities and Business Associates, must require HIPAA training for all workforce members that access protected health information (PHI) or electronically protected health information (e-PHI) in any of its forms and should be provided “as necessary and appropriate for the members of the workforce to carry out their functions within the [organization].”

According to the Rule, training must be provided “to each new member of the workforce within a reasonable period of time after the person joins the covered entity’s workforce.” Along with all other annual compliance requirements, HIPAA training is arguably the most important. Your workforce members are your first line of defense in the event of a Breach and must be able to identify your organization’s designated HIPAA Security Officer, and have a firm understanding of the HIPAA Privacy and Security Rule. Training should also highlight the organization’s Technical, Administrative, and Physical Safeguard objective security requirements. It is best practice to provide ongoing security awareness training and, in addition to the mandatory annual training, the Privacy Rule also highlights what’s known as “periodic” training. The goal is to ensure workforce member’s knowledge of HIPAA compliance is not forgotten.

The HIPAA Privacy Rule states that “An [organization] must document that the training as described [in the HIPAA Text] has been provided.” Failing to do so will be seen as “willful neglect” and will result in HIPAA violations including monetary penalties as high as $1.5 million dollars. A minor violation may only result in a corrective action plan requirement, whereas a significant data breach attributable to a lack of training will be viewed more seriously.

At Live Compliance, we make checking off your compliance requirements extremely simple.

      • Completely online, our role-based courses make training easy for remote or in-office employees.
      • Short informative video trainings to meet periodic training requirements
      • Contact-free, accurate Security Risk Assessments are conducted remotely. All devices are thoroughly analyzed regardless of location. Conducting an accurate and thorough Security Risk Assessment is not only required but is a useful tool to expose potential vulnerabilities, including those such as Password Protection.
      • Policies and Procedures are curated to fit your organization ensuring employees are updated on all Workstation Use and Security Safeguards in the office, or out. Update in real-time.
      • Electronic, prepared document sending and signing to employees and business associates.

Call us at (980) 999-1585 or visit www.LiveCompliance.com.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

Streamlining Your Practice with Medical Billing Software

Streamlining Your Practice with Medical Billing Software

EZClaim has been at the forefront of the medical billing software industry since 1997 with one goal in mind: to simplify the billing challenges for all providers. We at EZClaim understand that the healthcare billing process can be time-consuming and arduous, which is why we offer software that is easy to use, will focus on customer’s needs and can be specifically tailored to your practice.

Here are three essential reasons why you should be using medical billing software in your practice.

  1.     Improve Your Practice’s Billing Revenues

Did you know that the Academy of Healthcare Revenue estimates that providers have a 70 percent chance of collecting patient responsibility either prior to or at the point of service, compared to a 30 percent chance after the patient leaves?  EZClaimPay not only saves you and your team time but makes it easier to collect and record payments.

EZClaimPay allows your patient to make a payment at the point of service, and if they owe less than what they paid, you can offer a partial refund right from EZClaimPay. You can also keep a patient’s credit card on file, so if they owe more, you can get consent to charge the card on file. Additionally, there is no need to send out a statement; you can text or email the patient directly.

  1.     Useful in Processing and Tracking Medical Claims

There is no question that medical billing software is helpful for tracking and processing medical claims. If you are currently not utilizing a PM system, it is probably difficult to keep track of patient and insurance balances and claims that are under and overpaid, which means your practice could be losing money. With EZClaim, you will have much better control of your billing data.

 

Check out the video with real customer’s firsthand experiences on how easy and flexible EZClaim software really is:

 

  1.     Ease of Access

Using medical billing software allows your practice greater and easier access to all your patient data. By only logging into one program vs. numerous programs, you and your team will find it easier to answer questions for your patients. In addition, having your data seamlessly accessible will make processing payments more efficient.

Here at EZClaim, we understand that not all provider offices work the same. EZClaim software allows you to choose the additional tools and services that work best for how your practice operates. You can utilize the software as simple as you want or customize it to fit your practice’s specific objectives. With EZClaim Billing, you always have the option to grow.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.