In a press release issued by this morning, HHS Secretary Kathleen Sebelius noted that the roughly “$150 million will help community health centers provide in-person enrollment assistance to uninsured individuals across the nation.  About 1,200 health centers operate nearly 9,000 service delivery sites nationwide and serve approximately 21 million patients each year.”

According to the administration, the allocation of these funds will allow community-based health centers to hire new employees, better train existing staff, and further develop outreach and educational programs.

The new funding initiative “was issued by the Health Resources and Services Administration (HRSA), and it complements and aligns with other federal efforts, such as the Centers for Medicare & Medicaid Service funded navigator program.”

“Health centers work in communities across the country, giving them a unique opportunity to reach the uninsured in their communities and help connect them with the benefits of health insurance coverage under the health care law,” said HRSA Administrator Mary Wakefield, Ph.D, R.N.

For information on applying for this funding opportunity, visit http://bphc.hrsa.gov/outreachandenrollment/

For a list of health centers eligible to apply for this funding visit http://www.hrsa.gov/about/news/2013tables/outreachandenrollment/

The post Obama Administration Provides $150M for Health Insurance Enrollment Assistance appeared first on insidePatientFinance.

Realizing that successful collections require a staff that understands its goals and objectives and has the skills to handle difficult situations and negotiations with patients is essential. Training your team requires continued study and a positive attitude.

We are not dealing with patients of yesterday! Today’s economy combined with the unsettling numbers of uninsured and underinsured make it all the more important to handle patients in a manner that allows for a win-win situation for the patient and the facility.

Courtesy, compassion, dignity, and respect are required when making any contact with patients. In many cases, this is the first time a patient has received a phone call from a clinic or hospital. A caring, compassionate tone is not only the right thing to have with patients who are struggling with payment, but it is the most effective way to effect a positive outcome for both the patient and your facility.

Also, don’t forget to gather patient information and identification, as well as an understanding of a patient’s present financial situation, which will be key to a successful resolution.

The facility that does not maintain the following seven strategies will continue to scramble for self-pay dollars:

• Staff needs scripting for standards and expectations of the management team.
• Staff must role-play extensively in preparation for objections and patient disinterest in paying the bill.
• Phone calls should be concise and last no longer than 5-7 minutes.
• Train staff to be consistent with follow up after initial calls and hold the patient accountable for mutually agreed upon requirements during phone calls.
• Questions during the initial call must be clear enough to enable the team member to determine the likelihood of the patient cooperating.
• Telephone follow up should be specific in terms of expected payments and the time frame for each.
• Policies/procedures and expectations must be clearly and effectively stated to the patient.

The amount of education and training you provide your patient financial services counselors will in turn better equip them to provide the training to the person who needs it the most–the patient. The more you educate your patient base, the better your financial return.

About Chuck Seviour

Chuck has over 40 years of healthcare industry experience ranging from Director of Business Office Operations for a large health system to consulting with more than 150 hospitals for a major accounting firm. Chuck has been Vice President of Revenue Cycle for Array Services Group since 2004.

About Array

Array Services Group and its three innovative business units – CareCall, ProSource and J.C. Christensen & Associates – offer professional services in call management disciplines, accounts receivable and revenue cycle management, empowering clients for immediate and future success.

The post Seven Strategies for Managing Self-Pay Dollars appeared first on insidePatientFinance.

Patients have a right to know approximate out-of-pocket costs before they receive treatment. It is incumbent upon our patient financial services counselors to engage patients as early as possible and focus on educating them of their financial responsibility.

The need for financial counseling continues to grow as illustrated by the advent of:

• Higher healthcare deductibles
• Higher co-pays
• New Health Saving Account (HSA) policies
• More than 50 million uninsured/underinsured patients

Together these realities create an entirely new revenue situation completely different than the environment many of us remember in years past.

Enter the Financial Counselor

The “upfront financial counselor” has become a pivotal position in healthcare. As employees, we have an obligation to not only assist the patient in understanding his or her out of pocket cost but to educate them about their personal responsibility to pay it!

A Revenue Cycle team must have professional counselors. Many facilities move their counselors from collection positions to upfront positions based on their understanding of the dynamics of self pay and their ability to work with patients to pay their accounts early. This can be accomplished when counselors discuss the requirements of payment prior to the patient receiving service.

Management must support and train staff on collecting money at the time of service. While scripting and expediency are key elements of success for financial counselors, having compassion and treating patients with dignity and respect must be the number one priority when gaining patient commitment to pay.

Assisting patients who are unable to pay prior to treatments or who have large existing balances is an important role. This assistance can include assessing a patient’s liability, linking patients to available funding sources or determining whether they are eligible for charity care or financial hardship treatment.

Patients requesting payment plans or financial hardship assistance must be identified as early as possible in the registration/admission process. Three important factors to remember are:

• Financial counselors will have maximum effectiveness when they reach out to the patient first.
• Collection of money, though the top priority, does not mean non-collection has resulted in a poor call with the patient.
• Educating our patient about their fiscal responsibility is essential to the process.

Continue to Part Two …

About Chuck Seviour

Chuck has over 40 years of healthcare industry experience ranging from Director of Business Office Operations for a large health system to consulting with more than 150 hospitals for a major accounting firm. Chuck has been Vice President of Revenue Cycle for Array Services Group since 2004.

About Array

Array Services Group and its three innovative business units – CareCall, ProSource and J.C. Christensen & Associates – offer professional services in call management disciplines, accounts receivable and revenue cycle management, empowering clients for immediate and future success.

The post Managing Self-Pays Begins with Education appeared first on insidePatientFinance.

The downside to Medicaid expansion is that providing healthcare for low-income Americans does little if nothing to improve their physical health, the researchers found.

“The Oregon Experiment — Effects of Medicaid on Clinical Outcomes,” published in the latest number of the New England Journal of Medicine, is a study of a one-of-a-kind expansion of Medicaid by the Oregon Health Study Group. In 2008 Oregon held a lottery offering to expand Medicaid to almost 10,000 state residents, provided they met income, health insurance, and employment criteria. The Oregon Health Study Group then compared a sample of lottery winners with those from the same demographic who did not win.

In July 2011 the group released its preliminary results, which at least from a revenue cycle perspective were encouraging. “We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection),” the researchers wrote.

There were early indications that health improved as well as the researchers found “better self-reported physical and mental health than the control group.”

Later study of the data did not support that self-reported results, at least as far as physical health. “We found no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions,” the researchers wrote in the abstract to the New England Journal of Medicine article. “Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher.”

Expanding Medicaid failed to improve several markers of good health, it did encourage greater use of providers by the population while at the same time decreased the amount of medical debt, the researchers found.

The post Study Finds Medicaid Expansion Reduces Healthcare Debt but Fails to Improve Health appeared first on insidePatientFinance.

A survey by the Kaiser Family Foundation found that 49 percent of Americans say they don’t have enough information about healthcare reform to know how it will affect them or their families. Four in 10 Americans claim to be unaware that the ACA is still in effect, with 7 percent believing the Supreme Court had overturned the law and 12 percent believing it had been repealed by Congress.

The president yesterday told reporters that “we are pushing very hard to make sure that we’re hitting all the deadlines and the benchmarks,” but added that he expected there to be “glitches and bumps.”

Or a “train wreck.” Senate Finance Committee Chairman Max Baucus (D-Mont.), one of the original sponsors of the ACA, famously predicted that last week during a Senate hearing. “The administration’s public information campaign on the benefits of the Affordable Care Act deserves a failing grade,” he told Department of Health and Human Services Secretary Kathleen Sebelius during her testimony. “You need to fix this.”

Building the exchanges “is still a big complicated piece of business,” President Obama admitted in the press conference, and that roadblocks from Republicans, especially by not providing adequate funding, were making it more difficult.

The administration needs to bring the exchanges online by Oct. 1 when open enrollment begins for 2014. The Kaiser Family Foundation survey revealed that a majority of the most at-risk populations, those with low incomes and/or uninsured, say they lack enough information how the ACA will affect them and their family (56 percent and 58 percent, respectively).

The post Americans Ignorant About Healthcare Reform Law; President Promises Fix appeared first on insidePatientFinance.

Ten months ago the IRS released proposed regulations defining “extraordinary collection activities,” which are prohibited for any patient who may qualify for financial assistance. Until a nonprofit hospital can determine with certainty whether a patient qualifies, it must give that patient up to 240 days to fill out application for financial assistance. During that period neither the hospital nor its collection partners can report the delinquent bill to a credit reporting agencies, the proposed regulations state.

Healthcare provider organizations have argued that reporting a delinquent bill does not or should not qualify as an “extraordinary collection activity” and prohibiting it will hamstring them from collecting what they are owed. The IRS sought comments from the public on the regulations, and received more than 200.

If the regulations have been finalized, the IRS is keeping mum. There is a strong indication it will still be months before they are released. In a recent set of proposed rules regarding Community Health Needs Assessments released by the IRS earlier this month there was a brief statement regarding the status of the extraordinary collection activity rules: “The Treasury Department and the IRS intend to finalize the 2012 proposed regulations in conjunction with the finalization of these proposed regulations.” The proposed CHNA regulations cannot be finalized until after the comment period ends on July 5.

According to the regulation proposed last year, not-for-profit hospitals will not be able to engage in “extraordinary collection activities” until it has done the following:

• Provide patients with a plain language summary of the financial assistance policy before discharge and with the first three bills;
• Give patients at least 120 days following the first bill to submit an application for financial assistance before commencing certain collection actions;
• Give the patient an additional 120 days (for 240 days total) to submit a complete application;
• If a patient is determined eligible for financial assistance during these 240 days, refund any excess payments made before applying for aid and seek to reverse any collections actions already commenced.

Not-for-profit hospitals must report their respective collection activities for accounts receivable on Form 990 Schedule H. For Fiscal 2012, the most recent tax season, Schedule H contained no new information regarding exactly what extraordinary collection activities are, but did contain information about what they are not. Not-for-profit hospital are required to list whether it pursued collection activities such as reporting to a credit agency or filing lawsuits, liens, or body attachments. In the instructions for that section is a note, “No inference should be made regarding whether the actions listed … are ‘extraordinary collection actions.’”

Previously:

Associations Find Proposed IRS Regs for Healthcare Collections Burdensome

Treasury Department Proposes Specific Regulations Limiting Hospital Debt Collection

The post What Happened to the IRS 240-Day Ban on Hospital Bill Collections? appeared first on insidePatientFinance.

There are now several websites devoted to helping people raise money for various causes, and many of them are finding a booming business in crowdfunding for healthcare. Sites such as GoFundMe, Human Tribe Project, FundRazr, and GiveForward are regularly employed to fundraise for medical debt or upcoming expenses.

GoFundMe’s “Medical, Illness & Healing” category is the site’s most popular and raises millions of dollars month, the website’s CEO, Brad Damphousse, told the New Jersey Star Ledger.

“Just as we share parts of our lives on Facebook, we also want to share our dreams, pursuits, celebrations and challenges online with crowdfunding,” Damphousse said. “People will always be eager to support others they care about.”

“Most fundraisers are raising money from people they actually know,” YouCaring spokesman Michael Blasco told the newspaper. “The most generous donations typically come from people who are close to families.” On his site more than half of all fundraising requests are medical-related, he said.

If the internet does not work, there is always nude modeling for artists. Several Chinese publications have published the story of a farmer, Zhao Changle, who poses for artists to raise money for his son’s medical bills.

Previously:

One More Way to Help Patients Cope with Bills: Crowd Funding

The post Crowdfunding Helps Patients with Medical Debt appeared first on insidePatientFinance.

The Commonwealth Fund released its biennial survey of health insurance trends and found that the problem of healthcare, at least when it comes to health insurance coverage or the lack thereof, did not become bigger between 2010 and 2012, but that lack of insurance, underinsurance, and medical debt continued to be big challenges to a large percentage of Americans.

More than 40 percent of American adults ages 19 to 64 that were surveyed “reported problems paying their medical bills or said they were paying off medical debt over time,” according to the study. “Of those who reported difficulties paying medical bills or paying off medical debt, 42 percent said they received a lower credit rating as result of unpaid medical bills.” These figures were “statistically unchanged” between 2010 and 2012.

While healthcare providers the lack of growth is an indication that may mean uncompensated care will not increase as much as in previous years. The authors of the study attribute the flat results to young adults who became insured under their parents’ health insurance plans as part of the Patient Protection and Affordable Care Act (ACA). However the gains from that population group were offset by growth in the number of reported problems paying medical debt by the rest of the adult population.

The Commonwealth Fund, a major cheerleader organization for the ACA, claims that a white knight is approaching in the form of the mandatory health insurance requirement that begins on Jan. 1, 2014. The report’s authors believe this will reduce the number of self-pays and under-insured.

In 2012, almost one in six Americans reported that their medical debt had been sent to a collection agency, the survey found. One in four Americans reported that in 2012 they had to pay off medical debt over time, and of which 25 percent owed more than $4,000 and 16 percent owed more than $8,000.

Other results from the Commonwealth Fund survey include:

The share of young adults without insurance declined between 2010 and 2012;

Nearly half of adults either spent time without coverage or were underinsured in 2012;

Lower-income adults are uninsured and underinsured at higher rates;

Costs prevent many Americans from getting needed healthcare.

The entire report can be downloaded here.

The post One in Six Americans Had Medical Debt Go to Collections, Survey Shows appeared first on insidePatientFinance.

NBCnews.com has a examined the question, and found that although it is too early for hard numbers and answers, the medical costs for the 70 hospitalized victims is estimated to exceed $9 million.

(UPDATE: The New York Times weighed in on the same question today)

Massachusetts by law requires all its citizens to carry health insurance, but at least one of the victims does not have insurance. Jeff Bauman, who lost both legs, became a hero when upon waking up in the hospital he requested to speak to authorities because he could identify at least one of the bombers. His friends and family have created a charity to raise an estimated $300,000.

In addition, it is likely that many of the victims are not from Massachusetts, as the Boston Marathon attracts people from all over the world and is popular draw for students from Boston’s many universities.

A likely scenario, says the NBC writer, is that medical bills will be paid by a variety of insurances, by charitable donations, and by healthcare providers who write off the cost to charitable care. Massachusetts has launched The One Fund Boston for the victims which as of yesterday had raised more than $7 million.

The post As Victims Recover, Who Will Pay Medical Bills? appeared first on insidePatientFinance.

“Patient satisfaction” has little correlation to other measures of quality healthcare outcomes, according to a study by researchers at the Johns Hopkins University medical and public health schools. Another study published in the New England Journal of Medicine investigated “community benefit” by hospitals, and while it did not find fault with the metric, the study found the amount of community benefit provided by not-for-profit hospitals wildly variable.

In the patient satisfaction survey, the researchers found “little evidence supports its ability to predict the quality of surgical care,” the authors of the study wrote. One of the authors, Dr. Martin Makary, told Kaiser Health News that patient satisfaction gets a lot of attention by consumers because it is metric available to the public. “It’s going to mislead patients because they’re going to think the hospital with the best lobby and the best parking and customer service is going to have the best heart surgery,” he told the website.

Dr. Makary said he still considers patient satisfaction a valuable area to measure hospital performance, but that it receives too much emphasis compared to other measures such as metrics for surgical quality.

In the community benefit study, the researchers examined tax returns of 1,800 not-for-profit hospitals, basically repeating the research of the American Hospital Association (see link below). The results were roughly the same. According to the researchers:

Tax-exempt hospitals spent 7.5 percent of their operating expenses on community benefits during fiscal year 2009. More than 85 percent of these expenditures were devoted to charity care and other patient care services. Of the remaining community-benefit expenditures, approximately 5 percent were devoted to community health improvements that hospitals undertook directly. The rest went to education in health professions, research, and contributions to community groups. The level of benefits provided varied widely among the hospitals (hospitals in the top decile devoted approximately 20 percent of operating expenses to community benefits; hospitals in the bottom decile devoted approximately 1 percent). This variation was not accounted for by indicators of community need.

The study concluded that “tax-exempt hospitals varied markedly in the level of community benefits provided,” but that in all cases little was spent on community health improvement

Previously:

Patient Finance Benchmarks: Tax Returns Shed Light on Hospital Charity Care Thresholds

The post Studies Examine Metrics Used to Measure Hospitals appeared first on insidePatientFinance.