By most measures, this is not a good time for accounts receivable in healthcare. It is likely that somewhere from 5 million to 10 million Americans have lost their health coverage from layoffs and furloughs as a result of COVID-19. More than 40 percent of U.S. adults ages 19 to 64 are inadequately insured. Reports of health systems suing thousands of patients over unpaid medical debt in the midst of a pandemic have led to spectacularly bad press. Even as the global pandemic surges and health system margins plummet, new regulations on price transparency and surprise billing have taken effect.
And yet, as Winston Churchill said in a far more dire time, “never let a good crisis go to waste.” The fact that so many people are struggling offers an opportunity to take advantage of technology-enabled service solutions such as portals, apps and automated telephone outreach seeking to gauge patients’ ability and willingness to pay. In fact, there are so many technological approaches available that it has had the effect of slowing rather than accelerating adoption.
I would argue that prior to even looking to Big Tech as savior, it is time for some introspection. Most healthcare organization mission/vision statements refer to “patient-centered care” and “patient-friendly” billing policies. It is time to deliver on mission by providing the healthcare consumer with advocacy, navigation tools, flexible financing alternatives and convenient payment options that engender positive engagement and a higher probability of payment.
My company, Salud Revenue Partners, has coined the term “balance integrity” to describe how we work to ensure that patients are billed accurately only up to their financial means and only after we have exhausted every possibility of an insurer paying for the services.
Balance integrity requires accurate balances. Our definition of an accurate balance is that it matches the insurance explanation of benefits, and the balance does not include anything caused by a billing error. Providers must ensure that claims have been coded accurately, and that each field on a claim form, including modifiers, has been filled in appropriately.
When a provider makes an error, it can expect insurers to deny a portion of or the entire claim for complex reasons that cause some to simply pass the buck to patients to hash it all out. That amounts to a lot of buck-passing; a large academic medical center we have worked with had fully a quarter of all commercial claims denied, many with reasons such as “duplicate,” “non-covered,” “coding error” or “not medically necessary.” Providers’ payer follow-up staff need to advocate on behalf of patients and ensure that they solve challenging denials before a patient sees a bill.
Balance integrity means we evaluate and take into account a patient’s ability to pay. For the indigent or people with deductibles and co-pays beyond their means, providers should try to advocate on behalf of the patient with financial assistance, including charity write-offs, discounts, payment plans and perhaps a zero-interest credit card.
If there isn’t someone else who could be billed for services, balance integrity demands we assist patients with finding alternative insurance coverage, such as Medicaid or COBRA.
Balance integrity results in higher payments because most patients do not pay balances that they cannot afford, and insurers tend to pay more than patients. The industry should embrace price transparency instead of fighting it. If we truly want to be service-oriented, we need to do what’s right for the patient by ensuring that nobody facing a healthcare crisis should also confront the shock of a huge healthcare bill nobody told them would be coming and for which they are unprepared to pay.
When there is a legitimate balance owed by a patient with the means to pay, another opportunity arises to enhance the patient-provider bond. Platforms that use varying modes of communications such as interactive telephone outreach, texts and emails can also deliver custom messages to show appreciation of the patient, deliver marketing messages, and ensure that patients understand that financial assistance is available. They also link to today’s payment systems such as Apple Pay and PayPal, making the transaction instantly familiar to consumers.
The new realities of healthcare payment are complex, and technology-enabled services carry the hope of vastly improving efficiency and productivity of business office staff. They are even better as a means of putting an organization’s mission, vision and values to work in helping patients navigate the complexities of paying their fair share of the true price of care.
Jesse Ford is the founder and CEO of Salud Revenue Partners, a technology-enabled service company with experienced leadership and a high-performance culture that partners with healthcare providers nationwide to improve revenue cycle performance. For more go to saludrevenue.com/contact-us.
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January 28, 2021 at 02:26AM
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How to succeed on self-pay: think 'balance integrity' - Modern Healthcare
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