April 2012 Client Newsletter

COMBATING HIGH DEDUCTIBLE HEALTH PLANS

As mentioned a few weeks ago, we are seeing a significant increase in the # of HIGH deductible insurance plans – as high as $5,000 per year – with the resulting higher patient balances. Patients are taking longer to pay and even refusing to pay their deductible. Finding a way to avoid sending them to collections is important for your cash flow.

We are looking at various products to help you address this before it becomes a cash flow crisis. We think it may be better for you to receive 97-98% of your payment on the day of service, than 100% of nothing – or a long delay in getting paid. Practices are essentially becoming a bank/ loan officer for these patients!

Just wanted to keep you appraised of progress. When we attended our billing software’s Users Meeting last month, I met with several vendors. I am looking for something that is beyond simple credit cards, so that the increasing #’s of high deductible plans can be addressed in a more effective way with broader options – credit cards, electronic checks, HAS cards, and the occasional first born child!

So far several vendors meet the above criteria and offer:
*For those using our Appointment system, integration into the Hpac Appt. System to avoid double entry and ease of use to check eligibility and storage of that data.
*Credit cards (deposit direct to the client, and a report to CPB). Also sets up payment plans to automatically pay each month.
*Eligibility, including co-pay amount, deductible, amount of deductible already met. This
*Electronic patient statements – which can also direct patients to the patient portal for electronic payment.
*Patient portal (numerous benefits)

So far I have looked at 3 vendors with pretty good products & will look at one more.

We are still on track to select 1-2 to recommend to you by the end of April, tho hopefully a little sooner. You would have a great deal of flexibility as the vendors all seem to have an ala carte approach, as well as options within what you choose use. Or you could not use it at all.

Feel free to call with any questions.

THERAPY CAP AUDITS

As part of the Middle Class Tax Relief and Job Creation Act of 2012 (Job Creation Act) signed into law by President Obama on Wednesday, February 22, 2012, Section 3005 also mandates that Medicare perform manual medical review of therapy services furnished beginning on October 1, 2012, for which an exception was requested when the beneficiary has reached a dollar aggregate threshold amount of $3,700 for therapy services, including OPD therapy services, for a year. There are two separate $3,700 aggregate annual thresholds: (1) physical therapy and speech-language pathology services, and (2) occupational therapy services. These audits will be for charges being processed today so please be certain that these patients properly meet the Exception requirements.

ICD-10

CMS announced that they are delaying implementation of ICD-10 from the October 1, 2013 date. When the new date is announced, we will again begin to address it.


CHECKING MEDICARE PATIENTS FOR PREVIOUS ANNUAL WELL VISITS (AWV)

We have called Medicare to ask how a provider would know if a new patient had received other AWV services from another provider previously. We were told you can call Medicare and ask if patient received AWV services before. We have found some reps are more helpful than others.

INDUSTRY STATISTICS

One-sixth of the US economy is devoted to Healthcare Industry Statistics healthcare spending
• $2.6 trillion spent each year on healthcare in the US.
• $800 billion a year goes to care that is wasteful, redundant, or inefficient.
• On the current course, health expenditures will increase 6.1 percent per year on average over the next decade.
• Over $160 billion is spent on administration that does not go toward paying for health care.
• One of every seven claims is denied initially -- about 200 million claims out of the 1.4 billion submitted yearly.
• On average, national health insurers paid physicians in 33 days and denied 9.2 percent of claims.
• Administrative costs stemming from interactions between providers and insurers are estimated to total $31 billion a year.
• On average, a full 60% of a provider’s practice revenues is overhead.
• Commercial insurance companies have an error rate of almost 20% due to errors in claims processing, wasting almost $17 billion annually.
• 1 in 5 claims are not sent electronically.
• Almost 25% of all claims received no payment at all.
• The top reason claims are denied is patient eligibility. Other top reasons are missing information and services not covered.
• A 20% error rate in processing claims represents $3.6 million in erroneous claims payments, and an added $1.5 billion in unnecessary administrative costs.