Key Trends in Medical Billing and Patient Payments

by | Published on Apr 28, 2017 | Medical Billing

Medical Billing
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Physician practices that rely on medical billing services to improve their bottom line need to be up to date about the trends that are shaping healthcare revenue collection. The current scenario is a complex one where providers are striving to capture more revenue and many patients are facing surprise medical bills and finding it difficult to pay for their care.

  • Policy changes: Health care providers are impacted by policy changes and reimbursement trends, especially those related to Medicare, Medicaid, and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Providers need to stay the course with value-based models to improve care delivery and revenue. By anticipating what may be ahead, healthcare organizations can mold their strategy and tactics to deal with these changes.
  • Rising operational costs: The medical industry is facing an increase in operational costs and healthcare facilities can no longer afford to overlook A/R management. Changes in coding rules and the constant debate on fee structure are other key problems that healthcare providers have to contend with.
  • Patients confused about medical bills: Research shows 60 percent of patients are confused by medical bills. In addition to the lag time between services rendered and bills received, patients are confused about the amounts billed and owed, as well as the unexpected expenses that they thought their insurance covered. Providers need to adopt a compassionate approach to addressing these issues and answering patients’ billing questions. Insurance eligibility verification before services are provided is important not only from the physician’s point of view, but also for the patient as it informs them about their coverage. Increased payment option flexibility can also improve patient satisfaction.
  • Patients dread medical bills more than diagnosis: According to a Kaiser Family Foundation/New York Times survey, about 20 percent of insured Americans ages 18 to 64 and 53 percent of uninsured Americans said they struggled to pay medical bills in the past year. Other surveys showed that Americans are as worried about being diagnosed with a serious illness as they are about receiving a large, unaffordable medical bill, while some believe that the large medical bill is worse than the diagnosis.
  • States are taking action to protect consumers against balance billing: Surprise medical bills arise when an insured patient inadvertently receives care from an out-of-network provider, such as when being treated in an emergency. Surprise medical bills may also arise when a patient receives planned care from an in-network provider, but that care also involves physicians who are not in the same network. The provisions that states are taking to address the problem include limiting balance billing by out-of-network providers in certain circumstances and requiring health plans that require pre-authorization of facility-based care to notify enrollees that surprise medical bills could arise.
  • The medical billing outsourcing market is growing. A September 2016 Black Book survey of 2,000 independent physician practices and 200 hospital-based physician practices predicted that the U.S. market for physician and ambulatory revenue cycle management outsourcing is expected to increase by 42 percent from the fourth quarter of 2016 to the first quarter of 2019. According to a subsequent survey, 49 percent of hospital CFOs believed outsourcing, including offshoring, is becoming a more feasible option in 2017 for claims processing. Black Book predicts that the market for outsourced revenue cycle management will reach a value of $9.7 billion by 2018, growing at a CAGR of 26.5 percent over the next two years.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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