Don't Get Overwhelmed by Health Insurance Exchanges

In a little over eight months millions of Americans will be required to obtain health insurance or face a tax penalty. As several recent studies and media articles have demonstrated, those millions known almost nothing about those requirements.

Members of President Obama’s administration have promised in recent weeks that the federal government will publicize the new insurance requirement widely, but as healthcare providers in at least one state have already learned, the real promotion to low-income patients will be done by healthcare providers.

Massachusetts residents have been required to have health insurance for several years. Recently the Healthcare Financial Management Association (HFMA) published a case study of Boston Medical Center (BMC), which revealed it doubled its patient financial services staff temporarily to get as many of its patients signed up for health insurance as possible.

Most healthcare providers do not have the resources to increase staff so suddenly, so one option to consider is reaching out to your partners for additional help.

Beginning Jan. 1, 2014, there will be a land-office business signing up patients for insurance. As your patient financial services and/or patient access staff focus on that activity, your revenue cycle management partners, who are already familiar with your business processes and workflows, can be brought aboard temporarily to assist with functions not directly related to collections, such as billing, letter service, pre-collect, and first party contact.

And once the law is fully in effect, you might consider asking your collection partners to begin identifying and tracking those delinquent accounts who have failed to acquire insurance or those who may qualify for health insurance credits. By matching those results with those kept by your own staff you can identify those populations most at risk of failing to acquire insurance and develop strategies to best get the message out to them.

Finally, a loophole with health insurance exchanges in the Patient Protection and Affordable Care Act can be mitigated provided you and your collection partners are working together efficiently. Patients who fail to renew their insurance premiums through the health exchanges will have a grace period from the expiration of their policy to make good. After two months, insurers will deny any claims made by providers during that period, and providers will then be responsible for collecting directly from the patient. Your collection partner can assist in developing policies and procedures for handling these exigencies so that these patients will not fall through the cracks or waste needless administrative costs.

The transition to health insurance exchanges and new requirements of health insurance by all patients will be bumpy, but by working closely with all your partners you can quickly reach a place where the road smoothes out, the number of self-pays decline, and increased reimbursement from insurers for a greater percentage of your patient population.

John Owen is the Director of Client Development at DECA Financial Services in Fishers, Indiana. Check out other great content in the DECA Blog–Bottom Line Results Matter–on insidePatientFinance.com.