By Robert Foster
From Compliance Today, a publication for HCCA members
We all know the Affordable Care Act (ACA) in itself leaves several unanswered questions to the future of self-pay collections. In short, the ACA is a game changer. Many hospitals are asking how they can prepare for dealing with a new class of insured patients and plans, while keeping a customer service mind set and a strong Compliance presence.
With the rollout of the ACA, millions of previously uninsured people are now insured through public exchanges. It can be said that people with insurance are more likely to pay than those who are not insured. That in itself brings up two interesting points. First, what is the scale we are talking about? Second, what is the Compliance and customer service impact to those new patients who are now insured?
In terms of sheer volume, more than 910,000 people enrolled during the ACA 2014 open enrollment period (Oct. 1, 2013 – April 15, 2014). Of those, nearly 50% were uninsured. Those newly insured are taking full advantage of this newly acquired coverage as well. A large national healthcare system with 160+ hospitals experienced a 20% increase in ER visits and a 23% increase on the inpatient side between January 2013 and January 2015.[1]
However, this new insurance coverage from the ACA comes at a greater price. The same healthcare system between 2013 and 2015 experienced a 57% increase in ER visit balances as well as a 37% increase in inpatient balances after insurance had processed.
Hospitals are faced with dealing with patients who now owe a debt that they are not used to seeing. It’s not as simple as using a local business office to place calls to the patient and ask for payment. State laws, federal restrictions, and customer service issues make it almost impossible to keep up with this new market of patients. It’s also not just those restrictions that hamper collections. A large percentage of these new patients come from a generation that is more educated and knowledgeable as well as tech savvy. They have higher expectations and lower tolerance for inefficiency and poor service.
Taking these facts into consideration, you are now faced with the problem of how to collect from the consumer/patient while providing excellent customer service and staying compliant in a highly litigious environment driven by oversight of the Telephone Consumer Protection Act (TCPA), Fair Debt Collection Practices Act (FDCPA) and the Consumer Financial Protection Bureau (CFPB).
The best way to stay in compliance can go hand in hand with giving the best customer service. You can focus your staff to turn any uncomfortable situation into a positive outcome by using the following three Ls:
· Listen to the consumers’ needs
· Learn from the information obtained
· Lead them down a path that helps them
It’s paramount to keep in mind that these patients are using a new service. The fact of the matter is that some believed all services are covered at a 100% rate. When contacting them for payment, difficult conversations will usually follow. However, it’s how you help guide the operations staff in dealing with those consumers that will lead to a reduction in complaints to state agencies.
[1] Statistics are from a proprietary Parallon client survey.
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Robert Foster (CCCO) (Robert.Foster@Parallon.com) is a Compliance Manager and Assistant Ethics & Compliance Officer with Parallon Revenue Cycle Point Solutions in Louisville, KY.