Medical Billing Companies Spill About Outsourcing Operations

  A recent survey of medical billing companies shows a positive outlook on revenue cycle outsourcing, with many seeing payment collection as an opportunity. Nearly two-thirds of medical billing companies have a rising positive outlook about the current state of the revenue cycle outsourcing industry, according to a recent  survey  from Tebra.

Patient Collection Rate Falls to Nearly 48%

  A new analysis shows a sharp decline in the patient collection rate in 2022 and 2023 as providers write off more bad debt from patients with insurance. February 28, 2024  - Healthcare organizations are finding it harder to collect patient financial responsibility, a new  analysis  from Kodiak Solutions indicates. The analysis of patient financial transactions from over 1,850 hospitals and 250,000 physicians nationwide showed a sharp decline in the patient collection rate, from 54.8 percent in 2021 to just 47.8 percent in 2022 and 2023. Total payments made on the nearly 3 million fully resolved medical claims from commercially insured patients during the two-year analysis period were about $5.2 billion. However, the cash providers received was barely a quarter of the total charges, which were $21 billion at the time. Patient financial responsibility  accounted for about $1.1 billion of the over $5 billion in total payments received, or about a fifth of total payments. But providers co

Medicaid eligibility is changing and Ohio community health centers will take a hit.

  Medicaid eligibility is being re-determined in Ohio for the first time in three years. A federal mandate allowed Ohioans to stay enrolled in Medicaid insurance, even if their eligibility had changed, during the COVID-19 pandemic. Now the federal public health emergency has ended and April marks the end of that protection. More than 200,000 Ohioans are expected to be deemed ineligible and lose their coverage in the next year. The decline in Medicaid enrollment could mean big losses for community health centers, who largely serve low-income patients. Teresa Rios-Bishop, membership director of the Ohio Community Health Center Association, said the impact for centers will be significant. She said many communities are bracing for how this could change their care. “It certainly has a chilling effect for the patients and the health centers themselves,” she said. Nationally, total health center revenue is expected to decrease between four and seven percent, according to George Washington Uni

Ohio Doctor charged with Medicare conspiracy targeting Washington residents

  An Ohio Doctor has been charged in a fraudulent medical supply scheme that targeted elderly Washington residents. Thomas Andrew Webster, M.D., 50, of Sylvania, Ohio was charged with  one count of Conspiracy to Violate the Anti-Kickback Statue by targeting  elderly Medicare and TRICARE beneficiaries throughout Washington and other states, according to a press release from the U.S. Attorney for the Eastern District of Washington's Office. The conspiracy charge carries a maximum sentence of up to five years in prison. “Telemarketing schemes that target and exploit the elderly are especially pernicious because they prey on those who are often most in need of a doctor’s independent judgment that is not tainted or biased by the doctor’s own personal financial interest,” said U.S. Attorney Vanessa Waldref. Medicare and TRICARE provide health insurance coverage for eligible health care services, including, under certain eligibility conditions, for Durable Medical Equipment (DME). DME is

Staggering Number of Ohio Kids Have Lost Medicaid Coverage

  As kids' Medicaid eligibility review gets underway, experts are concerned about the number of Ohio children  losing federal health insurance . Kelly Vyzral, senior health policy associate, Children's Defense Fund-Ohio, said because Ohio does not disaggregate information by adult or child, there is little data available on why kids are dropping off. She added whether their parents obtained employer-sponsored coverage or they lost coverage for procedural reasons like a change of address, the tend is troubling. "So we don't know why the 61,000 kids have lost their Medicaid coverage," she explained. "But there's a difference in the total number of children covered in April, versus the number covered in July. That's 61,000." According to the Georgetown Center for Children and Families, more than 38% of Ohio children rely on Medicaid or K-CHIP coverage. At the start of the school year, kids often need routine immunizations and physical exams for spor

Fewer Than 1 in 3 Consumers Pay Medical Bills Immediately

  A recent survey shows most consumers— 72% — don’t or can’t pay their medical bills in full right away, with affordability being a top barrier. Healthcare revenue cycle leaders may need to readjust their patient collection strategy to help consumers understand and pay their medical bills, a new  survey  suggests. The survey of over 1,000 consumers conducted by AccessOne found that fewer than one in three respondents pay their medical bills in full right away, leaving a remaining 72 percent of consumers waiting to pay healthcare-related expenses. The latter respondents said they either can’t or don’t pay their medical bills right away and need different options and support. Some consumers who don’t pay medical bills immediately simply haven’t paid as of yet (13 percent), while 7 percent wait until just before the bill’s due date to pay in full and 2 percent pay after the due date. Affordability is a major challenge  for consumers. About 68 percent of consumers responding to the survey

3 key interventions to address lagging payer reimbursements

  It seems as if  commercial payers are doing all they can to keep from reimbursing providers in a timely manner. According to a recent  report by Crowe , 31% of claims submitted to commercial payers in the first quarter of 2023 were not paid for at least three months, as compared with 12% of Medicare claims. Medical necessity denials have risen as well. During the same timeframe, inpatient claims denied due to medical necessity issues were 3.2% among commercial payers and 0.2% for Medicare. Commercial payers have 12 times the denial rate that Medicare has based on requests for more information, according to Crowe. The following are three key interventions providers can implement now to help them do just that. Key intervention 1 Negotiation and contract m anagement optimization Hospitals can work with hundreds of payers, each with its own contract terms, processes,and ever-changing requirements. Managing these contracts can be challenging for resource-strapped organizations. However, i