What’s Causing Large Statement Balances?

A recent study showed that patient statement balances after insurance grew by more than 52 percent between 2012 and 2017. To break that down even further, that is an increase from 8 percent of the total statement to more than 12 percent. Approximately one-third of Americans can’t afford unexpected medical bills over $100 and many hospitals are struggling to find a solution to recuperate costs. 

Individuals who spent any time uninsured or who were underinsured reported to have problems paying large statement balances or said they would pay the medical debt over a long period of time. A quarter of those individuals who were always insured and did not meet the threshold of underinsurance also reported having problems paying their large statement balances.

Attempting to Collect Patient Payments

Many hospitals are attempting to collect payments from the patient at the time of service to address the problem of self-pay balances. The problem with that is that patients are usually at a loss for what their insurance will pay. Patients are typically going through very stressful situations where staff may feel uncomfortable trying to collect large payments. In addition, most hospitals don’t have the appropriate amount of staff or budget to follow up with patients by a phone call or mailing more than a couple of collection letters for their large statement balances. Other hospitals might not even have the technology or familiarity to offer payment plans or online payment options. 

Ways You Can Reduce Your Facility’s Outstanding Balances

One way that hospitals and providers can increase available resources is by participating in third-party early out solutions programs. Early out programs offer customer-oriented proceeding toward collecting balances from patients. Early out programs are very often successful with this because doing so is their main focus. In fact, early out programs are able to center their attention on patient collections at a much lower cost than a hospital trying to do the same. This is because hospitals would have to hire additional staff, pay for statement costs, credit card fees, additional phones and computers, employee benefits, and much more. 

Another way that you can reduce your facility’s outstanding balances is by making sure that the hospital leaders aim to implement a healthcare revenue cycle that is data-driven. This helps revenue cycle leaders to be able to know the hospital’s financial health of the organization. It also allows revenue cycle leaders to see if staff are performing their tasks efficiently to ensure quick reimbursements.

Offering Different Payment Options for Large Statement Balances

Early out solutions programs allow hospitals to offer more than one payment option to patients. Many individuals aren’t able to pay their large balance statements because of poor timing, lack of payment plan options, or having to pay for other bills. In addition, COVID-19 is now playing a huge role in financial hardships for individuals. Some may be experiencing a reduction of hours at their job, or some might be experiencing being unemployed altogether. 

When self-pay patients are notified of all of their options for payment plans, when they are educated about the financial assistance that is available to them, and when they are able to speak to someone on a personal level and someone who takes the time to sympathize with them to find a solution that works for them, they will be more likely pay and reduce large statement balances.

What’s Next?

With The Midland Group’s early-out program, patients are able to pay their financial obligation in full with no negative impact on their personal credit record or credit report. For hospitals, it is an opportunity to collect 100% of charges owed with greatly reduced administrative costs. Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

The post As a Healthcare Facility, How Do I Reduce Large Statement Balances? appeared first on The Midland Group.

Before the coronavirus pandemic, approximately 27.5 million Americans did not have health insurance. Since then, this number has increased dramatically. As businesses all over the country laid off close to 30 million U.S.workers, many more workers and their families have lost health coverage benefits. 

As a whole, COVID-19 has highlighted a significant gray area around healthcare billing, coding, resource allocation, and patient financial responsibility regarding coronavirus-related care. As such, it can be easy for people to get caught up in the whirlwind of ongoing updates and information regarding the specifics on coronavirus-related resources. 

To help you stay informed, our team has compiled a quick summary of the most important resources relating to the coronavirus and what that may mean for you and your family.

Families First Coronavirus Response Act (FFCRA)

In March 2020, Congress passed 2 stimulus bills aimed at assisting people without health coverage.

The first is the Families First Coronavirus Response Act. The FFCRA gave states the choice to use Medicaid to cover COVID-19 testing for those who are uninsured. While this testing covers both lab work and office visit, however, this bill does not help with actual treatment of COVID-19, should patients test positive.

While the Trump administration declined to reopen access to the Obamacare exchange, this concern did lead to the passing of another bill, the CARES Act.

Coronavirus Aid, Relief and Economic Security (CARES) Act

Complementary to the first bill, the CARES Act was designed to reimburse hospitals for coronavirus testing as well as necessary treatments for people who test positive. Reimbursements to healthcare providers are allocated from the bill’s $100 billion budget to be paid out at Medicare rates.

To qualify for reimbursement through this program, providers must have conducted testing and treatment on or after Feb. 4. In addition, providers must also complete the following steps: 

• Check the patient for coverage eligibility.
• Verify that the patient is truly uninsured and does not have any form of health care coverage, including any individual, Medicare, employer-sponsored, or Medicaid coverage.
• Confirm that no other payer source will reimburse the costs of testing and/or treatment conducted for the patient, whether partial or in full.

To learn more, visit COVID-19 Claims Reimbursement. In addition, providers can also begin the process to file reimbursement claims directly through the Claims Reimbursement Portal.

1135 Waivers for COVID-19

In certain circumstances, the Secretary of the Department of Health and Human Services (HHS) “using section 1135 of the Social Security Act (SSA) can temporarily modify or waive certain Medicare, Medicaid, CHIP, or HIPAA requirements, called 1135 waivers”. To help healthcare providers contain the spread of COVID-19 and address the financial issues presented, HHS has empowered the Centers for Medicare and Medicaid Services (CMS) to take proactive steps through 1135 waivers. In addition, the CMS has also been granted authority under section 1812(f) of the Social Security Act, which allows for blanket waivers to be implemented. When a blanket waiver is issued, providers are not required to apply for individual 1135 waivers. The blanket waiver related to coronavirus has a retroactive effective date of March 1, 2020 through the end of the emergency declaration. 

Examples of available waivers under section 1135 emergency authority include:

• Extend existing service authorizations until the end of the public health emergency
• Temporarily defer requirements for prior authorization
• Adjust specific timeline requirements for both state fair hearings and appeals
• Loosen deadlines for public notice and submissions in regards to specific Medicaid state plan amendments focused on COVID-19. This allows states to implement faster changes and thus ensure that they can be retroactive to the beginning of the emergency.
• Temporarily suspend prior authorization requirements;
• Extend existing authorizations for services through the end of the public health emergency;
• Modify certain timeline requirements for state fair hearings and appeals;
• Relax provider enrollment requirements to allow states to more quickly enroll out-of-state or other new providers to expand access to care, and
• Relax public notice and submission deadlines for certain COVID-19 focused Medicaid state plan amendments, enabling states to make changes faster and ensure they can be retroactive to the beginning of the emergency.

To learn more, visit COVID-19 Emergency Declaration Blanket Waivers for Health Care. For state-by-state 1135 waiver updates, visit Medicaid.gov’s Federal Disaster Resources. 

About the Midland Group

The Midland Group, in partnership with participating hospitals, is one of the very few companies that is able to deliver the highest returns from Medicaid and other public benefits. Since 1989, our goal has always been to increase people’s access to healthcare and protect the financial health of our partner hospitals. Even in times of unprecedented emergencies, The Midland Group stands by ready to assist patients in our partner hospitals to qualify for various public benefits programs. Our trained patient advocates are familiar with all the tools and ever-changing rules and regulations revolving around all forms of health-related public benefits. Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

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