Is Collecting for Medical Services Rendered More Challenging Now?

Revenue cycle management is a complex process that seems to have become even more complex these days due to the challenging pandemic situation. In short, the revenue cycle management process consists of collecting patient information, treating them appropriately, submitting claims to insurance companies for getting timely reimbursements and collecting the remaining dues from patients, if needed. But, due to increasing co-pays and high-deductible health plans these days, patients are facing more financial burden thereby increasing the load on the medical billers and other staff associated with collections. Add to this the impact of the value-based payment model and Affordable Care Act that are also leading to challenges in collecting money for services rendered.

 High-deductible Insurance Policies:

Let us see what high-deductible insurance policies are that are leading to collection challenges. For insurance plans, one needs to pay premiums. A high-deductible insurance plan is one that has a higher deductible than a traditional insurance plan. In such a plan, the monthly premium one has to pay is generally low; however, the policyholder has to bear more health costs (deductible) before the insurance provider starts to pay its share. Here, it’s necessary to understand what a deductible is. It is that portion of an insurance claim that the insured has to pay out of pocket and only upon paying this amount the insurance company will pay the other portion. So, from the healthcare facility’s point of view, when a patient with a high-deductible insurance policy is treated, the onus is on the billing department to collect the deductible from the patient.

High-deductible health plans are the only way to qualify for a ‘Health Savings Account’ that gives tax benefits. These plans are usually suitable for young and healthy people who generally don’t need health coverage with the exception of a severe health emergency. These can be opted for by wealthy people as well who are capable of paying the high deductible but want the benefits of the health savings account.

The rising popularity of high-deductible insurance plans is forcing some patients to delay paying their medical bills. In these difficult times of the pandemic when people are battling with not just health issues but employment and financial crises as well, collecting from patients has become a great challenge. This may result in an increase in money owed to healthcare facilities by patients and lead to bad debts over time.

In these tough situations, healthcare facilities must be careful in dealing with their account receivables and even consider sending their patients to collection agencies more quickly if they doubt them to be neglecting or trying to evade their out-of-pocket payments. It is even noticed that many healthcare facilities have started asking for payment before the service is provided to avoid collection issues later on.

Other aspects like claim denials are also adding to the burden of medical billers. Avoiding and managing claim denials effectively is essential to improve the efficiency of the revenue cycle of healthcare facilities. It is commonly observed that insurance companies can deny medical claims citing minute data errors and discrepancies. Sending accurate medical claims is of great importance because a denied claim costs both money and time for the medical billing department to resolve the issue. Submitting error-free claims is the best way to minimize denials and get your timely reimbursements, thereby improving your revenues. For this to happen, it is imperative to have a robust revenue cycle management process in place with adequately trained staff and cross-verification procedures in place, before submitting claims.

To achieve a healthy revenue cycle, healthcare facilities must either hire experienced and well-trained medical coders and billers or outsource their revenue cycle process to medical billing companies like Avontix, which offers exceptional medical billing services and help facilities focus on their core operations without worrying about their collections.

Is Collecting for Medical Services Rendered More Challenging Now?