When it was signed into law in March 2010 the Affordable Care Act aimed at both improving and expanding health care coverage for all Americans, while also protecting consumers from abusive practices by health insurance companies. Six years after its rocky rollout, major players in the health industry from insurance companies to providers to billing companies are still adjusting.
We recently asked several medical billing companies about the impact of the Affordable Care Act and patient pay on their businesses. Here’s what they had to say:
How has the Affordable Care Act affected your business? What about patient pay?
“It has probably increased the number of insured, but it has definitely not solved the problem of patient’s being responsible for so much more. Patients have such large deductibles and out-of-pockets to meet. I’m certain it impacts their visits to doctors and other healthcare providers.”
– Vanessa Higgins is the owner of, The Billing Department Inc., a growing billing company that specializes in helping small healthcare providers succeed.
“Under the Affordable Care Act (ACA), doctors have been strained by costly new regulations, complex payment ‘reforms’ that tie their reimbursements to complex federal reporting requirements, and mandates that they install and make ‘meaningful’ use of electronic health records.
The proportion of patients that doctors see are rapidly shifting away from commercial health plans and toward healthcare exchanges, which often times pay doctors pennies on the dollar that they were previously reimbursed under private insurance.
Doctors are opting out of these exchange plans for many reasons; chief among them is the fact that exchange plans offer significantly lower reimbursement rates than private market plans.
The proliferation of high-deductible plans (HDHP’s) is making consumers more price sensitive. Paying more out of pocket encourages people to shop for healthcare services.
Rising healthcare costs don’t only affect patients – they also threaten providers as well. As more and more people forego essential medical care due to insurmountable costs, practices lose patients.
Some providers are addressing this issue by going after self-pay patients. With self-pay patients, providers do not have to submit insurance claims, and patients pay their bill while they are still at the clinic; no lengthy collection process or accepting deep discounts from the payer.
Providers must rethink and retool their strategy for self-pay patients to include patients with high deductible health plans. The keys here are patient education and, literally, asking for payment.
Physician’s knowledge of their contracts and allowables are essential in determining how much to collect from their patients with HDHP’s.”
– Dana R. Bellefountaine Jr., president and CEO of CodeToolz, is a senior C-level executive with over 20 years of experience in Healthcare Finance and Accounting with medical practices ranging from single-physician startups to multi-physician, multi-specialty facilities. He has a considerable background in reimbursement methodologies and financial analysis and understands the current and emerging challenges that face the healthcare providers and partners with clients to address these issues and create opportunities.
“Due to the enormous volume of people, New York City is fairly insulated from the healthcare climate of the rest of the country. So, the ACA has not had a huge effect on us. That being said, the ACA is designed to provide more care and cut costs, which does not leave room for the out-of-network provider.
Patient deductibles and other out of pocket expenses are always on the rise, especially with the ACA plans. Patients that go out-of-network, however, always expect to pay more out of pocket, so the impact [of patient pay] on us is not very substantial.”
– Matt Dallmann is a Co-Founder of New York City’s VGA Billing Services, and specializes in out-of-network medical billing.
“Medical billing has always been a blend of government and private payers. The ACA has increased the number of insured while forcing some providers to consider the impact of reduced reimbursement.
Medicare is pushing toward quality- and outcome-based reimbursement and moving away from fee-for-service. In some cases, in addition to services provided, claims include additional codes describing current and expected outcomes. ACAs, Accountable Care groups, have had mixed impacts and success rates. This is partly due to that fact that many individual provider electronic health records (EHRs) do not currently share patient health data among the patient’s team of providers.
[Because of patient pay] patients are more aware of their co-pays and deductibles than ever. Eligibility and benefits are routinely checked prior to services being rendered, so there are fewer surprises after claims are processed. Today, both patient and providers have access to the same claims processing data on private insurance and government websites. It is, of course, important to collect the patient portion for care provided as it is part of the ‘allowed’ amounts determined by payers. Some practices simply bill patients a reduced rate to avoid having to deal with insurance at all. Others offer an annual surcharge in exchange for greater access to providers who promise to extend visit times and reduce overall patient load.”
– Bob Liepman owns Documed Medical Billing Services, which manages the entire revenue cycle for clients in the medical and behavioral health professions.
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Last Updated on October 31, 2016