Hayes' Healthcare Blog

Non-Medicare Payer Contracts and High Deductible Health Plans: 5 Things to Consider

Posted by Paul Fox on May 10, 2017 at 9:00 AM

Many non-Medicare provider contracts have unwritten ramifications of which you should be aware.  In today’s world of High Deductible Health Plans (HDHP) what you are really negotiating is your future self-pay liability until your patient’s deductible has been satisfied.  Do you have a viable strategy in place to understand what your organization’s options are and what you can/cannot do under your payer contract terms?  Additionally, should you insist certain clauses be present in the contract which will empower your facility to accurately collect at the time of service?

Here are five things to consider before entering into an agreement with a payer.

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Topics: high deductible health plans, Healthcare insurance

7 Ways to Plug High Deductible Health Plan Revenue Leaks

Posted by Paul Fox on August 3, 2016 at 9:00 AM

According to a recent report, three out of four employers now offer high deductible health insurance plans, up from just over two out
 of four five years ago.  At 22 percent of employers, it’s now the only option and nearly half of employers plan to make high deductible plans the only choice by 2018.[1]

high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher patient deductibles than a traditional plan. Choosing an HDHP is required if an individual wants to take advantage of the tax benefits of a health savings account (HSA/FSA). HDHP’s make employees personally responsible for a higher portion of their family’s healthcare costs, with the goal of motivating them to comparison-shop for medical services.

With an HDHP, consumers pay for all their medical services — at the insurer’s negotiated rate — until they meet their deductible. After that, consumers typically are responsible for a co-pay, normally 10 to 35 percent of the service — until they reach their out-of-pocket maximum. If payment isn’t collected at the time of service, the provider is left having to bill the patient for the remaining self-pay balances after a normal 20-40-day adjudication period. Most studies suggest the longer the self-pay account goes unpaid, the less likely it becomes that the provider will ever collect.

Can your organization survive under those financial terms? Most would answer an emphatic “no!”

There’s no question that HDHP’s are adding financial stress to healthcare organizations. Here are seven strategies you can use to help prevent revenue loss as a result of the growing use of HDHP’s.

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Topics: high deductible health plans, revenue cycle management, Healthcare insurance

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