The Billing Pros EMS - A Cvikota Company

Higher Deductibles and Co-pays Make Patient Payments Critical

Submitted Wednesday, May 13th 2015 6:49 am by Paul
in  Deductibles    Co-pay    Patient    Payments  

A new report by PriceWaterhouse Cooper shows what providers already know:  deductibles and co-pays are rising. In 2006 only 16% of insured individuals had deductibles of $1,000 or more. Today, the percentage is 61%. Yet, approximately 80% of consumers with commercial insurance incur less than $1,000 in out-of-pocket expenses in a year.  That means that many of your patients will pay for medical services themselves, with their insurance plans picking up none of the tab at all. 

Independent providers can take a little comfort in knowing that any one patient's deductible is spread across several physicians and practices. Still, it's a sobering thought for docs used to all but ignoring the patient responsibility side of the reimbursement equation, focusing instead on the larger dollars coming from third party payors.  To be sure, commercial and government payors will be largest slices in the reimbursement pie chart, but that's because a minority of patients are generating high dollar charges. 

"Savvy business office managers will need to be more attuned to patient responsible balances in the new health economy," said Curt Cvikota, President of the Healthcare Billing and Management Association (HBMA). "Successful participation in new pay-for-value models is only part of the reimbursement equation. As insurers shift financial risk to providers, it will become critical for managers to be effective in addressing patient responsible balances."

For many healthcare consumers, the doctor bill is the last one that gets paid. Some practices are providing information to patients regarding HSAs, budgeting, and personal debt reduction in order to move themselves to the front of the payment line. As one provider put it, "Debt free patients always pay their bills." To be successful, providers must educate patients regarding the certainty of out-of-pocket expenses and clearly communicate expectations for payment. Perhaps easier said than done, but it's the world we live in now.  

Point of contact (POC) collection of co-pays has been a staple practice for years, and more are taking advantage of patient eligibility and liability estimation tools.  A full suite of payment solutions may include E-Wallet, mobile payment apps, online bill pay, loyalty programs, PayPal, discounts for same day payment, payment plans, and patient credit financing. 

Healthcare providers who act to address the shift to high deductibles and co-pays will likely collect more of their patients' bills, and collect them more quickly, leaving less for the collection agency.

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