99284 Medicare reimbursement: $119.06
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ACEP Now: Vol 34 – No 07 – July 201599285 Medicare reimbursement: $176.27
Shift of patient from 99284 to 99285: +$57.21
Financial impact from a shift of 500 patients: +$28,605
These shifts in acuity can move in a negative direction as well. Today, we are in an environment requiring constant monitoring of the financial categories of ED patients as well as their acuities.
How to Manage the New Self-Pay Category
The increasing incidence of high-deductible patients within an ED practice brings into play an entirely different and new set of issues. These patients must accumulate significant health care charges before their insurance coverage kicks in. The bottom line regarding the delicate handling of these patients is to recognize them as a completely new self-pay type of patient. They are true self-pay patients until they hit their deductible threshold and have become a critically important part of your payer mix. The solution to this challenging situation is a sophisticated blend of technology, experienced people, and new and creative processes to engage these patients to ensure success with them. There must be creative statement protocols, phone calls, texts, and so forth to “meet patients where they live.” Today’s high-deductible patient is a critically important payer class, requiring new protocols and techniques to ensure proper collections. These are patients whose accounts cannot be mishandled, or they could become public relations problems in addition to challenging financial patients.
Practice management is changing these days, but don’t overlook the basics.
Mr. Holstein is a director of development with Zotec Partners.
References
- Lowes R. ACA at 5 years: 25 numbers to know. Medscape. March 30, 2015.
- Bowers K, Jacobs MO. 7 challenges for providers in the emerging consumer market. HFMA. March 30, 2015.
- Kaiser Family Foundation. 2013 employer health benefits survey. Accessed June 10, 2015.
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One Response to “Increase in High-Deductible Health Insurance Patients Raises Payment Concerns”
July 20, 2015
Myles Riner, MDHi, John
You have raised some important points. Here is one more: many of the patients who were insured under employer sponsored health insurance plans are migrating to the exchange plans, where deductibles are higher, and more importantly, contracted payments are substantially lower, as are benefits for OON services (these two are related phenomenon). The result of all of these changes as a result of Obamacare is that the important revenues derived from commercially insured services are shrinking and the ability of EM groups to cost shift to cover the losses associated with caring for Medicaid and uninsured patients is disappearing.