Why You Should Spend More Time Thinking About Medical Billing

By Michael Carroll on September 28, 2018

Much has been reported on the patient impact of the Affordable Care Act (ACA), and its subsequent debates and repeals. The good news is more patients have insurance coverage or come under Medicare. However, patients aren’t the only ones affected. Healthcare reform has brought about drastic changes for individual practices, and medical billing is one area that has felt the pain the most. In fact, a survey of 1,000 doctors from CompHealth found that 51 percent of physicians have an unfavorable view of the ACA.  Out of those in private practice, only 20 percent view the law favorably. Why? Among the reasons were more billing and insurance administrative work, with 68 percent saying they spend too much time entering data into electronic health records, and 59 percent saying they spend too much time doing paperwork related to billing. Physicians report that the greater administrative load has resulted in less time with patients. Additionally, doctors report that even though the ACA has provided greater access to health care, costs have increased. Those costs are often absorbed by the practice or billed to the patient. Has your billing strategy adapted with the evolution of healthcare? Consider three patient behaviors spurred by health care reform, and why these behaviors require a second look at your medical billing practices.

Patients are Bearing More of the Load

The number of patients that have high deductible health plans (HDHP) has taken a significant jump in recent years. In 2011, 26.3 percent of Americans age 18 to 64 had HDHPs. By 2016, that number jumped to nearly 40 percent, and it’s still increasing. A healthcare analysis from TransUnion reported an 11 percent growth in the average out-of-pocket costs for patients between 2016 and 2017. Average costs went from $1,630 to $1813. Patients are bearing more of the financial responsibility for their medical treatment.

What does that mean for providers? Simply put, insurers were more reliable payers. Individual patients have more variables in their lives that interfere with paying medical bills, especially unexpected ones. The TransUnion research found that 49 percent of patient expenses per health care visit were below $500, and 39 percent were between $500 and $1,000. Only 12 percent exceeded $1,000. So, we’re not talking about thousands of dollars. However, an unexpected $500 bill can be troublesome for patients. Another TransUnion study revealed that 68 percent of patients with a medical bill of $500 or less did not pay their full financial responsibility in 2016. Let’s say you saw 100 patients in a week. What if 68 of those did not pay their bill in full? No doubt your practice would be short thousands within just one month. The shift in patient responsibility is a huge reason to take a close look at your billing strategy.

Patients Want Transparency

For many patients, going to the doctor and paying a small co-pay are over. In previous years, many patients had no idea how much a basic exam would cost them. However, now that more costs are coming out of their pockets, they demand transparency. How are practices meeting this need? Not very well. One survey found that 63 percent of providers have trouble with price transparency. This is not due to simply not wanting to provide the information. Respondents said their biggest challenges were not having cost estimation tools and lacking the staff to research and implement those tools.

Note what one researcher from the TransUnion study concluded, “In order to allow patients to focus on getting the care they need, healthcare providers need processes and tools in place to help patients meet their financial obligations and to establish funding mechanisms that will benefit both the patient and provider.” Transparency is directly related to patients meeting their financial obligations. When patients are given accurate estimates well in advance of a procedure, they are more likely to be able to make arrangements for payment. Additionally, it’s not uncommon for patients to call several providers to inquire about the cost of services before deciding on a doctor. Health care has become a competitive environment. Are you losing patients because you don’t have the tools in place to provide accurate estimates?

E-Payments are in Demand

Despite the fact that e-payments are common in most industries, health care providers have been slow to adopt. A survey from MGMA and Navicure showed 77 percent of providers still use a paper-based billing system. Only 27 percent said their practice has an online bill payment tool. Twenty-two percent said they offer payment plans or credit-card-on-file options, and 11 percent have health care credit lines through a third-party vendor. An InstaMed report surveyed thousands of patients and found that 68 percent of patients want to pay their clinicians through electronic tools. However, only 20 percent have this option, and 86 percent still get paper bills.

More and more, patients expect their experience with their providers to mimic customer experience in other industries. The InstaMed report said patients value factors such as great customer service, delivering on expectations, making life easier and offering great value. A quality patient experience is not just their interaction with the clinician. It’s “meeting patient needs during the payment process,” according to the report.

What happens when practices don’t react to this shift in consumer preference? “Many in the industry are slow to recognize the new role of consumers as an industry stakeholder,” stated the report. “When consumer demands are ignored, the consequences are severe – irreparable damage to an organization’s brand resulting in lost patients and members, and ultimately revenue.” The truth is your billing strategy reflects on the practice’s brand. What does your medical billing process say about your practice? Are you forward-thinking, adapting to patient needs?

Making these changes can be overwhelming, especially when the change involves implementing new technology. Agnite Health is an outsourced billing company that offers a complete solution for your billing needs, and those of your patients. Learn more about how our tools can help you keep up with the demands of an evolving healthcare arena. Contact us to get started.