Pitching In: Reimbursement Strategies for High Deductible Health Plan Patients

By Patrick Holland

By design, high deductible health plans (HDHPs) increase cost sharing by patients, with the goal to reduce health care spending by making the financial impact of care decisions more transparent to decision makers. Theoretically, cost sharing can encourage better spending choices, or at the very least reduce unnecessary healthcare spending. For example, patients must now contend with the inappropriate use of medical care – like getting an MRI for a headache. And while these over-utilized services are common, patients may now think twice if these services are coming out of pocket.

With these major increases in patient cost sharing, providers are facing greater challenges in collecting outstanding balances and managing their accounts receivable. Health insurance exchange plans and HDHPs typically have high out-of-pocket payments for median income families, and in turn high out-of-pocket payments have the biggest impact on providers. However, there are strategies that hospital based physicians can employ to optimize collections from the high deductible patient population, especially where patient engagement technologies are concerned.

Follow-up Technology

Patient service personnel who are equipped with sophisticated technologies are likely to be more effective in the follow-up process. For instance, predictive dialers, call management and recording systems, screen capture software, and interactive voice response (IVR) can all ultimately impact collections. These technologies are often used separately in the patient collections process, but when deployed in a systematic way that provides various points of patient access, they will have far larger impact on the success of HDHP patient collections. Tactics to follow up with patients might include automated, customized calls made on an ongoing basis. Finally, secure billing portals that offer online payments as an option are critical among today’s internet-savvy patients who prefer to avoid the paper statement route.
As the credit card industry can attest, the more consumer touches there are, the more likely payments will be made – and the health care industry is certainly no different.

Business Intelligence Technology

Mining patient data and analyzing trends via the use of analytical tools will give practices greater insights as to how they might collect from this group of patients. For instance, real time analysis and reporting can help discover missing insurance, incomplete demographics, or other key front end data requirements enabling proactive action and reducing days in A/R vs. the traditional month-end reporting process. Effective data mining will enable practices to better identify processes and strategies that are or are not working in their collections efforts from HDHP patients. The ability to calculate patients’ out of pocket levels via real-time information is also helpful – at the time of service.

Besides Technology

The effective use of People, Process and Technology can help an ED practice collect on outstanding receivables – especially where the HDHP patient population is concerned. There are several other pieces of the puzzle that a practice must consider within the revenue cycle to achieve optimum results. These include:

  • Clear Billing Statements: Statements should clearly delineate the amount that is the patient’s responsibility, and why, as well as the payment due date, assuring clear, yet brief, language and terms.
  • Uninsured Patient Receivables: Does your group have a self-pay accounts management strategy that combines a series of targeted phone calls with progressive statements and letters to maximize patient contact?
  • Payment Plan Monitoring: It is important to negotiate payment terms, send monthly reminder letters, and follow-up on broken payment arrangements while being mindful of the group’s hospital’s guidelines in the process.
  • Additional Services: Specialized services including insurance identification, verification, billing, and bankruptcy reviews will no doubt ensure greater success in the collection of patient responsibilities.
  • In conclusion, an ED practice that creates an HDHP patient-centered billing and follow-up process may ultimately achieve greater success in their collection efforts. While patient friendly, efficient facilities and well-organized front desk processes are an important part of the ED environment, practices must also consider the same approach in patient collections to optimize their ongoing financial health. These approaches include helping patients understand their bills, timely and effective communications and collecting on deductibles and co-payments with a structured follow-up plan.

    Patrick Holland is a Director of Business Development with Zotec Partners