MAJOR REVENUE-CYCLE STRESS POINTS

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1 Healthcare Insights How Healthcare Reform Impacts Your Revenue Cycle: Scott Krah, AAP Vice President and Senior Product Manager Healthcare Payments KeyBank Enterprise Commercial Payments KEY TAKEAWAYS > A dramatic increase in the number of patients insured by high-deductible, high-copay plans will lead to more provider time spent collecting patient payments and more timeconsuming and complex transaction processing. > These challenges will be intensified by a number of other trends, including a rise in bad debts, the move to electronic payments processing, and a growing demand for greater cost transparency. > To succeed in this new environment, providers should follow revenue-cycle best practices and work with a knowledgeable financial partner. The most sweeping reform of healthcare since Medicare and Medicaid, the Patient Protection and Affordable Care Act (PPACA) is reshaping the landscape of medical service and insurance in the United States. Through a combination of individual mandates, employer requirements, public insurance exchanges, and Medicaid expansion, the PPACA is designed to bring affordable health coverage to millions of new customers. MAJOR REVENUE-CYCLE STRESS POINTS There s a tremendous amount of uncertainty concerning increased patient volume as the PPACA rolls out. Providers will have a steep learning curve for new policies sold on the exchanges, and a number of revenue-cycle management stress points are already surfacing. These include: Increased Patient Responsibility While 13 million people will gain coverage through the public insurance exchanges, 1 their new health plans will still leave them vulnerable to thousands of dollars in out-of-pocket expenses. In January 2014, the Department of Health and Human Services released a detailed set of statistics on public exchange insurance sign-ups. The data indicated that an older and more expensive population is signing up for insurance on the exchanges. One-third of the new enrollees were between ages 55 and 64, while only 24% were between ages 18 and Source: CBO, The Budget and Economic Outlook: (February 2014) 1

2 Insurance plans are changing in terms of patient responsibility, with consumers bearing more of the costs for their healthcare. Since many new policyholders are newly insured or in different plans than those with which they were accustomed, establishing payment accountability will be much more complicated. Chris Seib, Chief Technology Officer and Co-Founder of InstaMed, a Healthcare Payments Network The report also included information on what kind of plan people purchased: Marketplace Plan Selection by Level October 1, 2013 December 28, 2013 Silver Bronze Gold Platinum Catastrophic 60% Source: Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Health Insurance Marketplace: January Enrollment Report for the period: October 1, 2013 December 28, 2013 (January 13, 2014) 20% 13% 7% 1% The data showed 80% of consumers choosing Silver and Bronze plans, which have the highest deductibles and co-pays. 2 People with these plans will bear significant responsibility for their healthcare bills meaning providers will be busier than ever collecting payments from patients. This shift toward greater patient responsibility is putting more pressure on revenue-cycle management, causing providers to rethink how they handle payments at every step. As a result, transaction processing will become more time consuming and complex. A Rise in Bad Debts Difficulties in collecting patient payments will cause bad-debt management to occupy much of a provider s time in the future. With high deductible and co-pay insurance, providers could be stuck with trying to collect the unpaid cost of treatments. Even when doctors tell clients that they are responsible for a portion of their bill, getting advance payments will be difficult if neither the provider nor the patient knows the exact dollar amount needed. In the end, while the provider may get at least some portion of the payment, there will also be more vetting to do and more bad debt. Predictably, higher levels in health cost-sharing leads to financial strain at the household level. A Kaiser Family Foundation review of National Health Interview Survey data revealed that people in higher-deductible plans are more likely to have difficulty paying medical bills (34%) compared to people in lower-deductible plans (24%). 2 There are four metal levels for plans in the healthcare exchanges Platinum, Gold, Silver, and Bronze featuring increasing degrees of patient responsibility. A fifth, Catastrophic coverage level exists solely for individuals who are younger than 30 or have been exempted from the individual mandate because there s no affordable coverage available to them. 2

3 An important objective of PPACA is to encourage the shift from manual and paper-based processing to EFT and ERA. New rules are designed to create as much standardization and consistency in healthcare electronic transactions as possible and help smooth the way to electronic payments. Priscilla Holland, AAP, CCM, Senior Director of Healthcare Payments, NACHA Percent of Privately Insured Adults with Difficulty Paying Medical Bills, 2012 *Low Deductible is defined as less than $1,200 for a single policy or less than $2,400 for a family policy. Source: Kaiser Family Foundation analysis of 2012 National Health Interview Survey data. Greater Need for Processing Efficiency LOW DEDUCTIBLE* HIGH DEDUCTIBLE Unable to pay at all 4% 7% Problem in the last 12 months 11% 17% Paying off over time 21% 31% Any problems over period longer than one year 24% 34% The new environment is putting significant pressure on healthcare providers to streamline and automate billing and insurance-related processing. Industry usage of electronic payments systems is still low, with electronic funds transactions (EFT) and electronic remittance advice (ERA) accounting for only about one-third of total transactions nationwide. While many providers have been moving aggressively to electronic payments, a large portion of smaller providers still rely on manual, paper-based systems that limit opportunities for efficiency gains. These offices will have the biggest challenge to adapt. BEST PRACTICES FOR PROVIDER ORGANIZATIONS As improving payments efficiency and dealing with revenue-cycle pressure points becomes increasingly important, there are some best practices that every provider organization should follow: 1. Improve Messaging It is always best to have up-front messaging in person or voice-to-voice, such as calling a patient a couple of days ahead of their appointment to tell them what they ll need to do when they arrive. One approach that we frequently see is taking a credit card number and telling the patient that it will only be charged if needed, said Chris Seib, chief technology officer and co-founder of InstaMed, a healthcare payments network. 2. Set Patient Expectations Setting and managing patient expectations is absolutely essential, including communicating with the patient about what to anticipate from their insurer. For example, telling someone before surgery, We ve contacted your insurance carrier. They will pay $X and you will owe $Y. The ideal situation is that there are no surprises and consumers know their payment responsibilities up front. 3

4 Other Trends in the Healthcare Environment In addition to the PPACA, several other factors are also intensifying financial pressure on providers. Employer Plan Changes: Employers are asking their employees to share an increased percentage of their healthcare expenses. Reduced Provider Access: The shortage of physicians is likely to get worse with the influx of the newly insured, and policies offered on the exchanges will provide access to smaller networks of providers. Increased Provider Consolidation: Consolidation will continue at the facility or hospital and physician levels, with increased hospital acquisition of both primary care and specialist doctors. Increased Transparency: Employers will demand more data to help them determine how to control costs and make their communications and engagement more patient-centered. The Move to Electronic Payments Processing: Within the next several years, providers will find that adopting electronic billing and insurance-related systems will be the only way they can stay in business. 3. Train Staff Training is critical for each and every staff member who has a role in the payment and collection process. For example, the person checking the patient in or out may now need to do more payment-related communications and tasks. Providers need to devote sufficient time and attention to ensuring their personnel understand their new roles and can meet expectations. Billing and insurance-related staff who are new to the electronic payments systems required by PPACA must also be trained in the new processes. 4. Emphasize Post-Service Payment and Collection Payment vehicles such as online bill paying, direct debits to checking, and paying by mobile open up new opportunities for providers to get paid in a timely way. 5. Make Effective Use of Technology The benefits of electronic transactions for healthcare payments reduced operating costs, efficient processing, enhanced reliability, and strengthened security are widely agreed upon. Advances in automation and electronic processing will play a major role in revenue-cycle management, and going electronic will be the only way to keep accounts receivable under control. WORKING WITH A TRUSTED FINANCIAL PARTNER By working closely with banks and vendors, providers can develop integrated, cost-effective solutions in this rapidly changing environment. It s good to have a trusted partner with services and solutions that deal with complexity and simplify payments processing, said Seib of InstaMed. Working with the right technology professionals in this complex industry today can mean the difference between success and failure. Financial services institutions can help providers seamlessly connect transactions processing with other services to address their full range of payments needs, including cash management, accounts receivable financing, and enhanced patient payment options. Providers are discovering how important it is to work with financial specialists who understand the healthcare industry and its unique characteristics and needs. For more information on how KeyBank can help you with revenue-cycle management in the new environment, contact Scott Krah at or 4

5 Scott Krah, AAP Krah is Vice President and Senior Product Manager at KeyBank. He has more than 15 years of experience developing and delivering healthcare payment products aimed at shortening the revenue cycle. He can be reached at: or About Key Healthcare Key Healthcare provides solutions and services to nearly 10,000 hospitals, physician and dental practices, senior housing centers, outpatient facilities, and other healthcare providers. Key is one of the country s largest healthcare lenders with approximately $7 billion in credit commitments. Further, Key ranked No. 2 nationally in healthcare real estate originations in 2011 and No. 1 in Freddie Mac senior housing lending in with nearly $1 billion in volume. Key Healthcare delivers the full resources of KeyBank, one of America s largest financial services companies by providing clients with deep expertise in healthcare finance, revenue-cycle management, strategic advisory services, and wealth management. Key Healthcare s dedicated local teams help clients with optimizing their capital structures, adapting to regulatory changes, enhancing employee benefit packages, ensuring timely reimbursement, and preparing and executing plans for growth or expansion. In addition, Key offers comprehensive planning solutions for growing, protecting, and transitioning wealth along with specialized programs to help ensure the financial health of our clients employees. For more than 160 years, Key has been committed to supporting the organizations and individuals that support the health of our communities. Headquartered in Cleveland, Ohio, Key has assets of $89 billion. Learn more at key.com/healthcare. KeyBank is providing this brief overview to raise awareness concerning the changing economic landscape. The information and recommendations contained herein are compiled from sources deemed reliable, but are not represented to be accurate or complete. In providing this information, neither KeyBank nor its affiliates are acting as your agent, broker, advisor, or fiduciary, or are offering any tax, accounting, or legal advice regarding these instruments or transactions. If legal advice or other expert assistance is required, the services of a competent professional should be sought. Before entering into any financing arrangement, please seek counsel from your own financial, tax, accounting, and legal advisors. Key.com is a federally registered service mark of KeyCorp KeyCorp. KeyBank is Member FDIC. E

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