CFPB Healthcare Trends

CFPB Finalizes Nov. 30 Effective Date for Reg F: Health Care Trends to Watch

The CFPB had proposed delaying the original effective date by two months to allow additional time for supervised entities to comply, but decided the extension was unnecessary based on public comments.

The Consumer Financial Protection Bureau’s original effective date for the final debt collection rule (Regulation F) has been finalized as Nov. 30, 2021.

In its proposal earlier this year to delay the effective date, the CFPB stated that it proposed the extension in response to the ongoing “societal disruption” caused by the global COVID-19 pandemic and to allow stakeholders additional time to review and implement the rule.

However, the CFPB said it has “now determined that such an extension is unnecessary” and that the public comments generally did not support an extension, according to a news release.

“ACA appreciates that the bureau listened to concerns raised in our comments highlighting that the proposed delay would not effectively address any concerns raised about compliance burdens in the rule, and it did not align with our actions taken by the bureau in response to the pandemic,” said ACA International’s Vice President and Senior Counsel of Federal Advocacy Leah Dempsey.

With the official compliance date in mind, health care providers working with collection agencies as their business associates should ensure they’re on the same page about text message and email requirements under Reg F.

As explored in the March issue of Pulse, three core areas of Reg F compliance are the definition of “consumer,” limited content voicemail and call frequency.

Definition of ‘Consumer’

CFPB Definition of a Consumer
CFPB Definition of a Consumer

Deceased consumers leaving debts behind are now included in the definition of “consumer.”

This means when you have an account where the consumer has died, you will need to determine if a survivor can work with you to resolve the debt. The FDCPA allows debt collectors to communicate with certain family members and legal representatives.

Remember, you cannot demand payment from survivors. The payment must come from the deceased consumer’s assets.

Limited Content Voice Mail

CFPB Limited Content Voice Mail
CFPB Limited Content Voice Mail

Leaving voicemail messages can sometimes lead to third-party disclosure. To help us reach consumers and protect the consumer’s privacy, the CFPB has designed a script template called “Limited Content.”

There are certain things that debt collectors will be able to say but nothing more. Follow your new script exactly and practice it until it becomes routine. Do not add or change anything in your new script without your manager’s approval.

Frequency

CFPB Frequency
CFPB Frequency

The new rule says that a debt collector cannot call a consumer more than seven times in a seven-day consecutive period for each debt. After having a conversation with a consumer about a particular debt, the debt collector cannot call the consumer again about that debt for seven consecutive days.

If you’re thinking, “What if…” you’re not alone! There are a lot of complicated issues with this new rule and as such, it’s important to rely on your compliance and training team for guidance. Dialing systems will help.

Keep accurate notes for each call. Remember to indicate any requests from the consumer to contact them in a different way or at a more convenient time or place.

The CFPB will consider additional guidance for debt collectors, including those that service mortgage loans, as necessary, and continue to work with all market participants to ensure a smooth and successful implementation.

The entire ACA team is excited to prepare members for these historical changes to the FDCPA. Set your coordinates for ACA Education and Events for new lessons on how to prepare for the rules. Visit acainternational.org/events for Core classes, Hot Topics, ACA Huddles and more to keep you moving forward in 2021.

ACA has also created an educational video series, ACA How: Reg F Implementation, to help you prepare for Reg F compliance: https://www.acainternational.org/about/reg-f



About Mnet

We believe every patient deserves a helpful, transparent, easy-to-navigate financial experience in healthcare.

Mnet is the premier revenue cycle management & technology provider to the surgical industry. Mnet provides customized patient-pay solutions to surgical hospitals and ambulatory surgery centers. Mnet Health partners with over 900 surgical facilities nationwide and is the preferred vendor to the leading ASC management companies in the US both directly with and in support of centralized billing offices.

Mnet’s tailor-made brand, PaySUITE, is a white-labeled payment technology platform that helps surgical facilities, and their providers grow their business by helping patients pay. Mnet’s patient-pay solutions significantly increase self-pay collections while creating a better financial experience for patients. For more information, visit mnethealth.com.


Impacts of COVID-19 Pandemic Cause Increase in Health Care Consumerism

Health care consumerism—when patients take more control over researching their medical care and associated expenses—is on the rise in response to the COVID-19 pandemic, according to TransUnion Healthcare’s second annual patient survey.

The September 2020 survey of more than 3,000 consumers who had either visited a hospital, health care clinic, doctor’s office or other health care organization for treatment during the past 12 months shows that nearly six in 10 patients (59%) deferred non-COVID-19 related medical care during the past six months, according to a news release from TransUnion.

Results of the survey also show 49% of survey respondents—an increase of seven basis points from 2019—reported the current economy has influenced how they seek medical care to some extent.

“Our latest survey illustrates to providers just how important it is to offer flexible care delivery options and payment experiences for their patients during this period of uncertainty, as well as understand and address individual payment needs,” said David Wojczynski, president of TransUnion Healthcare.

Economic challenges are causing younger generations to drive health care consumerism. For example, one-third (33%) of Generation Z and 29% of millennial patients reported their health insurance coverage was impacted due to the pandemic (compared to 22% of overall respondents, 18% of Generation X and 12% of baby boomers), according to the news release.

There is also a tie between the increasing trends in health care consumerism and price transparency requirements for health care providers (outlined in our cover article in this issue).

Additional findings in the survey include:

  • 80% of respondents utilized either health care provider or payer/insurance websites, among other sources, to research health care costs, compared to 75% in 2019.
  • Among younger generations, 90% of Generation Z respondents and 87% of millennial respondents researched these resources compared to 69% of baby boomer respondents.
  • 47% of recent patients selected their health care provider based on cost.
  • When it comes to price transparency, the survey shows 53% of recent patients received clear cost estimates prior to receiving medical care.
  • While the number of patients receiving clear cost estimates did increase from 2019, TransUnion found only 52% of respondents completely understood their financial responsibility for their recent medical bill.

More information: https://bit.ly/32Vki5b See Data Watch for a chart from the survey.


About Mnet Health

We believe every patient deserves a helpful, transparent, easy-to-navigate financial experience in healthcare.

Mnet is the premier revenue cycle management & technology provider to the surgical industry. Mnet provides customized patient-pay solutions to surgical hospitals and ambulatory surgery centers. Mnet Health partners with over 900 surgical facilities nationwide and is the preferred vendor to the leading ASC management companies in the US both directly with and in support of centralized billing offices.

Mnet’s tailor-made brand, PaySUITE, is a white-labeled payment technology platform that helps surgical facilities, and their providers grow their business by helping patients pay. Mnet’s patient-pay solutions significantly increase self-pay collections while creating a better financial experience for patients. For more information, visit mnethealth.com.


Price Transparency

Spotlight on Price Transparency

The Centers for Medicare and Medicaid Services’ Transparency in Coverage rule takes effect Jan. 1. Hospitals and their collection agency partners can work together to ensure this information is effectively communicated to consumers.

Not only can consumers hop online to check out prices for products they have their eyes on, like a car or vacuum, now they have more resources to comparison shop for their health care.

In January, a Centers for Medicare and Medicaid Services (CMS) rule will take effect requiring U.S. hospitals to provide pricing information online in two ways:

  • As a comprehensive machine-readable format file containing prices for all items and services offered by a hospital.
  • In a display of at least 300 shoppable services in a consumer-friendly format.

The Transparency in Coverage rule materialized from President Donald Trump’s executive order on “Improving Price and Quality Transparency in American Healthcare,” with the goal to increase price transparency and allow for consumers to make health care decisions before going to the hospital, according to CMS.

The rule was finalized in November 2019 and compliance is required by Jan. 1, 2021.

Price transparency is not a new area of focus for hospitals by any means and most have some sort of price estimator tool in place; the question is how accurate the information will be based on what is required in the new rule, ACA International members say.

“The key goal in all of this is to give the patient and consumer accurate out-of-pocket prices for the services they’re receiving,” said George Buck, former president emeritus of Frost-Arnett Company and an accounts receivable management industry consultant specializing in health care.

Price Transparency—Is it Accurate?

Health care providers and their business associate partners should look at price transparency in a similar perspective as to how they would address a “least sophisticated consumer” under the Fair Debt Collection Practices Act.

For example, Buck visited the websites of the three major medical providers in a metropolitan center and priced out an arthroscopic knee surgery to repair a meniscus tear. On two of the sites, he said it was easy to find the price estimator tool, but on the third site it was not available, at least not at that time.

On the two websites with a price estimator tool, Buck said the difference in the information they asked for was significant and the results presented two different prices for the surgery.

“The thing that was missing for me, and I think consumers are not going to realize, is that in each of these cases, there is a charge for anesthesiology and there’s a charge for the surgeon. And there may be other charges such as pathology or radiology,” Buck said.

Business associates of health care providers can help train clients on consumer communications about those issues.

This was part of the goal of the Healthcare Financial Management Association (HFMA) Medical Accounts Receivable Task Force when it developed best practices for the resolution of medical accounts in 2014. The best practices were updated in 2020 and include a focus on price transparency.

According to CMS, in addition to listing the prices for items and services, hospitals must also list plain-language descriptions of the services, group them with ancillary services and provide the discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.

When the COVID-19 pandemic hit in March, it presented some challenges for hospitals as they were preparing for final compliance with the rule. Their attention shifted to caring for patients with COVID-19 and providing testing. For the last several months, price transparency pages on some hospitals’ websites listed more services related to COVID-19 than other options, they said.

The final rule equips CMS with new enforcement tools including monitoring, auditing, corrective action plans, and the ability to impose civil monetary penalties of $300 per day to ensure hospitals comply.

What’s Next? A Payer Rule

In October 2020, as part of the price transparency executive order, CMS also issued a final rule requiring similar online cost disclosures by health insurance companies.

“The rule requires group health plans and health insurance issuers in the individual and group markets to not only provide easy-to-understand personalized information on enrollee cost-sharing for healthcare services, but they must also publicly disclose the rates they actually pay health care providers for specific services,” according to CMS.

On Jan. 1, 2023, like the rule for hospitals, health plans will be required to offer an online shopping tool displaying negotiated rates between their doctor and their insurance plan, as well as an individualized estimate for out-of-pocket costs. Effective Jan. 1, 2024, online tools displaying prices for medications, medical equipment, follow-up procedures and other items or services consumers may need will be required, according to CMS.

Katy Zillmer is ACA International’s communications manager.


About Mnet Health

We believe every patient deserves a helpful, transparent, easy-to-navigate financial experience in healthcare.

Mnet is the premier revenue cycle management & technology provider to the surgical industry. Mnet provides customized patient-pay solutions to surgical hospitals and ambulatory surgery centers. Mnet Health partners with over 900 surgical facilities nationwide and is the preferred vendor to the leading ASC management companies in the US both directly with and in support of centralized billing offices.

Mnet’s tailor-made brand, PaySUITE, is a white-labeled payment technology platform that helps surgical facilities, and their providers grow their business by helping patients pay. Mnet’s patient-pay solutions significantly increase self-pay collections while creating a better financial experience for patients. For more information, visit mnethealth.com.


Snapshot: Best Practices for Patient-Friendly Billing

ACA International and the Healthcare Financial Management Association reconvened this year to update best practices for the fair resolution of patients’ medical bills. Here is a look at patient-friendly billing principles highlighted in the report.

Patient-friendly billing is part of the core framework of best practices recently updated by ACA International and the Healthcare Financial Management Association (HFMA) Accounts Receivable Resolution Task Force. The best practices focus on the fair resolution of patients’ medical bills and address financial assistance policies in response to the COVID-19 pandemic.

The report reflects the task force’s consensus on the equitable resolution of the patient portion of medical bills.

ACA and HFMA worked together on the 28-page report, which updates and extends guidance that was originally published by HFMA in 2014. The report emphasizes the importance of educating patients and ensuring that they understand the account resolution process.

Serving on the task force are ACA’s CEO Mark Neeb, ACA’s Vice President and Senior Counsel of Federal Advocacy Leah Dempsey, and ACA members from State Collection Service Inc.: Tim Haag, president, and Steve Beard, chief business development officer.

With a focus on patient education and communication, the best practices are designed to help patients engage in their health care and become active participants in resolving outstanding accounts.

The report includes best practices for modifying financial assistance policies in response to the COVID-19 pandemic and recommended safeguards to implement before initiating actions, such as credit bureau reporting, that some hospitals and their business affiliates may elect to pursue in accordance with account resolution policies that have been approved by the hospital’s board of directors or other authorizing body.

As part of the focus on patient-friendly billing, the task force’s goal was to identify a common set of account resolution best practices that align with the federal requirements and with HFMA’s patient-friendly billing principles.

The principles are designed to simplify the process for patients, according to the report.

It states that, following the principles, health care financial communications will be:

  • Clear. All financial communications will be easy to understand and written in clear language. Patients will be able to quickly determine what they need to do with the communication.
  • Concise. Bills will contain just the right amount of detail necessary to communicate the message.
  • Correct. Bill items will correctly reflect the patient’s responsibility after the claim has been adjudicated and/or financial assistance or other discounts have been applied, as appropriate.
  • Patient-Friendly. The needs of patients and family members will be paramount when designing administrative processes and communications.

Since the task force’s 2014 report was issued, the group expanded its guidance for conversations with patients to include education and engagement that will provide a clear understanding of what they can expect at every stage of the account resolution process. Health care providers or their business associates should start patient education as early as possible during the account resolution process, but their efforts should not stop there.

“The best practice is for the provider or business associate to offer ongoing education to reinforce the opportunities (e.g., financial assistance, payment plans, other sources of coverage) patients have for positive account resolution,” according to the report. “Therefore, providers and business associates must use every patient communication to engage and educate the patient about their account resolution options.”

The report maps out the entire medical accounts receivable resolution process from preservice to post-discharge, incorporating elements from HFMA’s Patient Financial Communications Best Practices and Patient-Friendly Billing initiative.

The report was developed with the support of State Collection Service.

Members of HFMA’s 2020 Medical Accounts Receivable Resolution Task Force include a diverse group of providers, consumer advocates and collection agencies.

Access the report and additional resources from the task force here: https://www.hfma.org/dollars


About Mnet Health

We believe every patient deserves a helpful, transparent, easy-to-navigate financial experience in healthcare.

Mnet is the premier revenue cycle management & technology provider to the surgical industry. Mnet provides customized patient-pay solutions to surgical hospitals and ambulatory surgery centers. Mnet Health partners with over 900 surgical facilities nationwide and is the preferred vendor to the leading ASC management companies in the US both directly with and in support of centralized billing offices.

Mnet’s tailor-made brand, PaySUITE, is a white-labeled payment technology platform that helps surgical facilities, and their providers grow their business by helping patients pay. Mnet’s patient-pay solutions significantly increase self-pay collections while creating a better financial experience for patients. For more information, visit mnethealth.com.


ACA International and HFMA Release Best Practices for Resolution of Medical Accounts

The updated best practices build off the work of a 2014 task force and reflect an ongoing commitment to help patients resolve their medical bills.

ACA International and the Healthcare Financial Management Association Medical Accounts Receivable Resolution Task Force reconvened this year to update best practices for the fair resolution of patients’ medical bills and address financial assistance policies in response to the COVID-19 pandemic.

The report reflects the task force’s consensus on the current state of best practices related to the equitable resolution of the patient portion of medical bills.

ACA and HFMA worked together on the 28-page report, which updates and extends guidance that was originally published by HFMA in 2014. The report emphasizes the importance of educating patients and ensuring that they understand the account resolution process.

Serving on the task force are ACA’s CEO Mark Neeb, ACA’s Vice President and Senior Counsel of Federal Advocacy Leah Dempsey, and ACA members from State Collection Service Inc.: Tim Haag, president, and Steve Beard, chief business development officer.

“ACA members have been working with consumers over the past several months to help them understand their options and provide solutions to financial challenges,” Neeb said. “We greatly appreciate the collaboration with HFMA and the other partners to develop best practices for fair resolution of medical debts that document ACA members’ compassionate approach and their commitment to continue serving consumers throughout the COVID-19 crisis and beyond.”

With a focus on patient education and communication, the best practices are designed to help patients engage in their health care and become active participants in resolving outstanding accounts.

“This year was a critical time to revisit and update these best practices on behalf of health care providers and accounts receivable management companies with the goal to help consumers resolve and understand their medical bills,” Neeb said. “We know medical debt sometimes comes with added challenges and uncertainty and it is the mission of the accounts receivable management industry and its health care provider partners to work together to offer solutions, education and guidance.”

The report includes best practices for modifying financial assistance policies in response to the COVID-19 pandemic and recommended safeguards to implement before initiating actions, such as credit bureau reporting, that some hospitals and their business affiliates may elect to pursue in accordance with account resolution policies that have been approved by the hospital’s board of directors or other authorizing body.

The framework for the best practices includes:

  • Patient-Friendly Billing – The task force’s goal was to identify a common set of account resolution best practices that align with the federal requirements.
  • Patient Education – Education should be designed to engage patients and help them understand their financial responsibility with regard to their account balance, including what it is made up of and how to resolve it.
  • Communications – Providing a clear understanding of what to expect at every stage in the process helps patients engage in their health care and become active participants in resolving outstanding accounts.
  • Price Transparency – Providing patients with access to price estimates is a core part of the education and engagement process. The price estimate allows for tangible discussion of the patient’s obligation and facilitates discussion of potential sources of coverage, financial assistance and payment plans, as necessary. When hospitals have highly reliable price estimates for scheduled services, these estimates should be provided to patients proactively

This report emphasizes the importance of patient education early in the accounts resolution process, but educational efforts should not stop then. The best practices are for the provider or business associate to offer ongoing education to reinforce the opportunities (e.g., financial assistance, payment plans, other sources of coverage) patients have for positive account resolution. Therefore, providers and business associates must use every patient communication to engage and educate the patient about their account resolution options.

The report maps out the entire medical accounts receivable resolution process from preservice to post-discharge, incorporating elements from HFMA’s Patient Financial Communications Best Practices and Patient-Friendly Billing initiative.

The report was developed with the support of State Collection Service. “The creation of best practices will enable health care providers, their business partners and patients to work collaboratively, in a consistent manner, to resolve outstanding accounts,” Haag said. “Our goal is to provide empathetic, knowledgeable assistance to both providers and patients by offering all possible solutions in account resolution.”

Members of HFMA’s 2020 Medical Accounts Receivable Resolution Task Force include a diverse group of providers, consumer advocates and collection agencies.

Access the report and additional resources from the task force here.


About Mnet Health

We believe every patient deserves a helpful, transparent, easy-to-navigate financial experience in healthcare.

Mnet is the premier revenue cycle management & technology provider to the surgical industry. Mnet provides customized patient-pay solutions to surgical hospitals and ambulatory surgery centers. Mnet Health partners with over 900 surgical facilities nationwide and is the preferred vendor to the leading ASC management companies in the US both directly with and in support of centralized billing offices.

Mnet’s tailor-made brand, PaySUITE, is a white-labeled payment technology platform that helps surgical facilities, and their providers grow their business by helping patients pay. Mnet’s patient-pay solutions significantly increase self-pay collections while creating a better financial experience for patients. For more information, visit mnethealth.com.


Hospitals Receiving CARES Money Banned from Surprise Billing on COVID-19 Cases

Hospitals accepting money from the massive CARES Act legislation will not be permitted to send patients surprise bills for visits associated with COVID-19, according to ABC News.

It has been widely reported in the past two months that the Trump Administration signed the bipartisan CARES Act legislation to provide relief to American families, workers, and the health care providers on the frontline of the COVID-19 outbreak. In April, the U.S. Department of Health and Human Services announced additional allocations of the CARES Provider Relief Fund to include $100 billion for health care providers including hospitals.

In allocating the funds, the administration sought to address the economic harm across the entire health care system due to the stoppage of elective procedures along with the economic impact on providers incurring additional expenses caring for COVID-19 patients, according to a press release issued by HHS.

The prohibition on surprise billing will protect patients covered by government programs, employer plans, or self-purchased insurance. Hospitals that accept the grants are required to certify that they will not try to collect more money than the patient would have otherwise owed if the medical attention had been provided in-network, ABC News reported.

Below are some additional highlights included in the Provider Relief Fund.

Access to Care

  • President Trump secured commitments from private insurers, including Humana, Cigna, UnitedHealth Group, and the Blue Cross Blue Shield system, to waive cost-sharing payments for treatment related to COVID-19 for plan members.
  • The Families First Coronavirus Response Act, as amended by the CARES Act, requires private insurers to waive an insurance plan member’s cost-sharing payments for COVID-19 testing. The president also secured funding to cover COVID-19 testing for uninsured Americans.

Rural Providers

  • $10 billion was allocated for rural health clinics and hospitals.
  • This money was distributed on the basis of operating expenses, using a methodology that distributes payments proportionately to each facility and clinic.
  • Rural hospitals are more financially exposed to significant declines in revenue or increases in expenses related to COVID-19 than their urban counterparts, HHS reported.

Uninsured

  • A portion of the $100 billion Provider Relief Fund reimbursed health care providers, at Medicare rates, for COVID-related treatment of the uninsured.
  • Every health care provider who has provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursement through the program and will be reimbursed at Medicare rates, subject to available funding.
  • The government began accepting claims in early May 2020. For more information, visit coviduninsuredclaim.hrsa.gov.

High Impact Areas

  • $10 billion was allocated for targeted distribution to hospitals in areas that have been particularly impacted by the COVID-19 outbreak. As an example, hospitals serving COVID-19 patients in New York, which has a high percentage of total confirmed COVID-19 cases, were expected to receive a large share of the funds.

Sources:

The ABC News story titled, “White House says no ‘surprise’ bills for COVID-19 patients,” may be accessed here: https://tinyurl.com/ycnomdu4

The HHS press release titled, “HHS Announces Additional Allocations of CARES Act Provider Relief Fund,” may be accessed here: https://tinyurl.com/y75nqal4


About Mnet Health

We believe every patient deserves a helpful, transparent, easy-to-navigate financial experience in healthcare.

Mnet is the premier revenue cycle management & technology provider to the surgical industry. Mnet provides customized patient-pay solutions to surgical hospitals and ambulatory surgery centers. Mnet Health partners with over 900 surgical facilities nationwide and is the preferred vendor to the leading ASC management companies in the US both directly with and in support of centralized billing offices.

Mnet’s tailor-made brand, PaySUITE, is a white-labeled payment technology platform that helps surgical facilities, and their providers grow their business by helping patients pay. Mnet’s patient-pay solutions significantly increase self-pay collections while creating a better financial experience for patients. For more information, visit mnethealth.com.

Have a question? Contact Us Now


Physician Practice Patterns Changing As a Result of COVID-19

The COVID-19 crisis presented our society with a host of unexpected challenges and changes that could impact the way we interact with co-workers, family members – and doctors.

Consider this, a survey of physicians conducted at the height of the COVID-19 crisis found that nearly half of its respondents (48%) were treating patients via telemedicine. This figure is up from 18% in 2018, according to a press release issued by study authors Merritt Hawkins, a physician search firm and an AMN Healthcare company, and the Physicians Foundation, a nonprofit advancing the work of physicians.

Other findings from the survey include:

  • 38% of physicians are seeing COVID-19 patients
  • 60% of physicians who are not seeing COVID-19 patients are willing to do so
  • 21% of physicians have been furloughed or experienced a pay cut
  • 14% of respondents plan to change practice settings as a result of COVID-19
  • 18% plan to retire, temporarily close their practices, or opt-out of patient care
  • 30% who are treating COVID-19 patients are feeling great stress but will continue to see patients

Meanwhile, about one-third of physicians (32%) indicated that they will change practice settings, leave patient care roles, temporarily shut their practices, or retire in response to COVID-19. This should be of particular concern to hospitals and other health care organizations already struggling with physician shortages and turnover, according to Travis Singleton, Executive Vice President of Merritt Hawkins.

“Once the pandemic has been contained there will be a backlog of procedures and pervasive COVID-19 testing. Physician re-engagement and retention will be of even more importance,” Singleton said.

“Even prior to the COVID-19 pandemic, physicians were expressing dissatisfaction in their jobs and experiencing high rates of burnout and mental health issues caused by stressors like regulatory burdens and EHR [electronic health record] use,” said Gary Price M.D., president of The Physicians Foundation. “The pandemic is straining physicians further and we need to prioritize providing solutions that will ease the financial and emotional burdens they are feeling as a means to improve their wellbeing now and after the crisis is resolved.  It is the least we can do for the health care workers who are risking their lives to take care of everyone else.”

A positive takeaway of the survey is, of the physicians who are currently not treating COVID-19 patients, 60% are willing to do so and one-third (34%) have more time due to the decline in office visits resulting from the pandemic.

Survey data is based on responses from 842 physicians across the country and the survey has a margin of error rate of +/- 3.5%. Further information about the survey can be accessed at www.merritthawskins.com or https://physiciansfoundation.org/.

Sources:

The press release may be accessed here: https://tinyurl.com/yc6f83mr


About Mnet Health

We believe every patient deserves a helpful, transparent, easy-to-navigate financial experience in healthcare.

Mnet is the premier revenue cycle management & technology provider to the surgical industry. Mnet provides customized patient-pay solutions to surgical hospitals and ambulatory surgery centers. Mnet Health partners with over 900 surgical facilities nationwide and is the preferred vendor to the leading ASC management companies in the US both directly with and in support of centralized billing offices.

Mnet’s tailor-made brand, PaySUITE, is a white-labeled payment technology platform that helps surgical facilities, and their providers grow their business by helping patients pay. Mnet’s patient-pay solutions significantly increase self-pay collections while creating a better financial experience for patients. For more information, visit mnethealth.com.

Have a question? Contact Us Now


Blind Spots

By now, most collection agencies working in the health care space are aware of Section 501(r) financial assistance policy requirements for tax-exempt charitable hospitals organized under section 501(c)(3) of the U.S. Code.

While these regulations have been in place for some time and have not been amended since their enactment, it’s always beneficial to review your compliance procedures to ensure there are no gaps or potential blind spots. Likewise, for those thinking of entering the health care accounts receivable market, it can be crucial to understand these requirements in order to attract potential clients and reassure them about your operations.

The Affordable Care Act, enacted in 2010, added section 501(r) to the Internal Revenue Code with the intent of encouraging hospitals to devote more resources to charity care. In 2014, the IRS and the U.S. Treasury issued final regulations implementing the provisions of section 501(r).

Section 501(r) applies to charitable “hospital organizations” that assert the provision of hospital care as the basis for their tax-exempt status under section 501(c)(3). The IRS’s implementing regulations impose four requirements on these hospital organizations: (1) a community health needs assessment; (2) a written financial assistance and emergency medical care policy; (3) a limitation on charges; and (4) a limitation on certain collection actions.

Collection agencies and debt buyers need to pay attention to the billing and collection requirements imposed by the regulations, as well as the notification requirements relating to the hospital’s’ financial assistance policies (FAP).

Under the billing and collection requirements, hospitals must make “reasonable efforts” to determine a patient’s eligibility under the FAP before engaging in “extraordinary collection actions” (ECAs) against that individual. This prohibition extends not only to the ECAs against the patient, but also against “any other individual who has accepted or is required to accept responsibility for the [patient’s] care.”

Under the regulations, a hospital will be deemed to have engaged in an ECA if any purchaser of the individual’s debt, any debt collection agency, any other party to which the hospital facility has referred the individual’s debt, or any substantially related entity has engaged in such an ECA.

ECAs include activities that require a legal or judicial process. For example:

• Placing a lien on an individual’s property;
• Foreclosing on an individual’s real property;
• Attaching or seizing an individual’s bank account or other personal property;
• Commencing a civil action against an individual;
• Causing an individual’s arrest;
• Causing an individual to be subject to a writ of body attachment, and Garnishing an individual’s wages.

As set forth in 26 CFR Section 1.501(r)-6, ECAs do not include: (1) certain debt sales; (2) liens on certain judgments, settlements, or compromises; and (3) claims filed in a bankruptcy proceeding.

Before pursuing an ECA, a hospital must make “reasonable efforts” to notify the individual about the hospital’s FAP. Additionally, a hospital must wait 120 days before initiating an ECA against a patient whose FAP-eligibility is undetermined.

The regulations also provide a 240day period, during which a hospital facility is required to process any application submitted by the individual. While the requirements to notify patients of the FAP prior to taking an ECA ultimately apply to the hospital, collection agencies that contract with hospitals may have an obligation to meet these regulatory requirements.

And while neither the statute nor the regulations provides for a private right of action for violations, a failure to comply can jeopardize the tax-exempt status of the hospital, potentially raise liability related to the loss of that tax-exempt status, and spoil the debt collector or debt purchaser’s relationship with the hospital. As a result, both hospitals and their agents must understand the regulations.

Fortunately, ACA International members have access to SearchPoint document #6248, “501(r) Final Regulations for Charitable Hospitals,” which our compliance analysts have recently updated with new case law. It’s always beneficial to work with your charitable hospital clients to periodically review any collection and billing policies to ensure procedures are being followed by the hospital and agency.


About Mnet

We believe every patient deserves a helpful, transparent, easy-to-navigate financial experience in healthcare.

Mnet is the premier revenue cycle management & technology provider to the surgical industry. Mnet provides customized patient-pay solutions to surgical hospitals and ambulatory surgery centers. Mnet Health partners with over 900 surgical facilities nationwide and is the preferred vendor to the leading ASC management companies in the US both directly with and in support of centralized billing offices.

Mnet’s tailor-made brand, PaySUITE, is a white-labeled payment technology platform that helps surgical facilities, and their providers grow their business by helping patients pay. Mnet’s patient-pay solutions significantly increase self-pay collections while creating a better financial experience for patients. For more information, visit mnethealth.com.


U.S. Chamber Publishes COVID-19 Loan Guide to Help Small Businesses

During the height of the COVID-19 pandemic, the U.S. Chamber of Commerce created a guide to help small businesses, independent contractors and other related business personnel prepare to file for a coronavirus relief loan under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, according to a press release issued by the Washington, D.C.-based organization.

The U.S. Chamber’s Coronavirus Small Business Guide (available at uschamber.com/sbloans) outlines the steps small businesses should take to prepare to access much-needed funds to help keep their workers on the payroll during this disruptive period. Further guides will be developed as the CARES Act is implemented.

“The U.S. Chamber of Commerce is working with state and local chambers across the country to provide businesses with the information they need to stay afloat and keep people employed during the pandemic,” said Suzanne Clark, president of the U.S. Chamber of Commerce. “This comprehensive guide ensures small business owners fully understand what aid is available to them and how to access those funds as quickly as possible. We remain committed to ensuring no family or business goes bankrupt due to financial hardships associated with the coronavirus.”

Additionally, to help small businesses, the U.S. Chamber of Commerce compiled an interactive map to show the aid available to the public on a state-by-state basis (click here https://tinyurl.com/wtyb2zy for additional information).

In March, Congress passed the CARES Act which allocated $350 billion to help small businesses keep workers employed amid the pandemic and economic downturn. Known as the Paycheck Protection Program, the initiative provides 100 percent federally guaranteed loans to small businesses that maintain their payroll during this emergency. Furthermore, these loans may be forgiven if borrowers maintain their payroll during the crisis.

The U.S. Small Business Administration posted additional guidance (https://tinyurl.com/uon96cm) about the Paycheck Protection Program to its website in April, including a sample application.


About Mnet

We believe every patient deserves a helpful, transparent, easy-to-navigate financial experience in healthcare.

Mnet is the premier revenue cycle management & technology provider to the surgical industry. Mnet provides customized patient-pay solutions to surgical hospitals and ambulatory surgery centers. Mnet Health partners with over 900 surgical facilities nationwide and is the preferred vendor to the leading ASC management companies in the US both directly with and in support of centralized billing offices.

Mnet’s tailor-made brand, PaySUITE, is a white-labeled payment technology platform that helps surgical facilities, and their providers grow their business by helping patients pay. Mnet’s patient-pay solutions significantly increase self-pay collections while creating a better financial experience for patients. For more information, visit mnethealth.com.


HHS Resolves 99% of HIPAA Related Complaints

Since the compliance date of the Privacy Rule in April 2003, the U.S. Department of Health and Human Services Office of Civil Rights (OCR) received over 225,378 Health Insurance Portability and Accountability Act (HIPAA) complaints and initiated over 993 compliance reviews.

As of Dec. 31, 2019, the office resolved 99% (222,175) of cases. More than 27,600 cases were resolved by requiring changes in privacy practices and corrective actions by or providing technical assistance to HIPAA covered entities and their business associates. OCR settled or imposed a civil money penalty in 73 cases resulting in a total dollar amount of $111,855,582.00.

Various types of entities have been investigated to include national pharmacy chains, major medical centers, group health plans, hospital chains, and small provider offices. In another 12,094 cases, OCR investigations found that a violation had not occurred. Additionally, in 40,882 cases, OCR intervened early and provided technical assistance to HIPAA covered entities, their business associates, and individuals exercising their rights under the Privacy Rule, without the need for an investigation.

In the remainder of the cases (141,595), OCR determined that the complaint did not present an eligible case for enforcement. These include cases in which:

  • OCR lacks jurisdiction under HIPAA. For example, in cases alleging a violation by an entity not covered by HIPAA;
  • The complaint is untimely, or withdrawn by the filer; and
  • The activity described does not violate the HIPAA Rules. For HIPAA VIOLATIONSHHS Resolves about 99% HIPAA-Related ComplaintsHealth plans are among the least likely entities to violate the rule. For example, in cases where the covered entity has disclosed protected health information in circumstances in which the Privacy Rule permits such a disclosure.
  • From the compliance date to the present, the compliance issues most often alleged in complaints are, compiled cumulatively, in order of frequency:
  • Impermissible uses and disclosures of protected health information;
  • Lack of safeguards of protected health information;
  • Lack of patient access to their protected health information;
  • Lack of administrative safeguards of electronically protected health information; and
  • Use or disclosure of more than the minimum necessary protected health information.

The most common types of covered entities that have been alleged to have committed violations are, in order of frequency:

  • General Hospitals;
  • Private Practices and Physicians;
  • Outpatient Facilities;
  • Pharmacies; and
  • Health Plans (group health plans and health insurance issuers).
  • Referrals

OCR refers to the Department of Justice (DOJ) for criminal investigation appropriate cases involving the knowing disclosure or obtaining of protected health information in violation of the Rules. For additional information, click here: https://tinyurl.com/lgzxpye


News & Notes

Texas Makes it Easy

The Texas Medical Association (TMA) produced a seven-page summary of the surprise-billing law (Senate Bill 1264) passed by the Texas Legislature in 2019. TMA’s overview explains topics such as when the law applies, and how the arbitration process works. The summary is accessible here: https://tinyurl.com/tvyxhvy

Payback: West Coast Doc Pays Penalties

The California Department of Managed Care (DMHC) settled a lawsuit against Dr. Nancy B. Way, “requiring her to stop illegally balance billing California enrollees,” and to pay $13,000 civil penalties. In response to the action, DMHC Director Shelley Rouillard recommends that consumers check their bills and contact their health plan if they have questions. Additional information may be accessed here: https://tinyurl.com/vrtl7bg.


Congress Eyes Medical Debt in New Legislation

ACA continues to maintain open lines of communications with lawmakers as they consider moving forward with legislation that could impact the way the industry approaches medical debt collections.

House Legislation

In December, the House Financial Services Committee marked-up legislation titled, “Consumer Protections for Medical Debt Collections Act” (H.R. 5330), which would prohibit medical debt reporting for a year, and would ban reporting on debt arising out of “medically necessary procedures.”

Introduced by U.S. Rep. Rashida Tlaib (D-Mich.), the legislation would also prohibit collecting medical debt for two years.  These proposed restrictions would make it difficult for accounts receivable management industry professionals seeking to collect rightfully owed debt while creating a disastrous situation for medical providers caring for patients.

Senate Legislation

Meanwhile, ACA has had numerous discussions with lawmakers in the House and Senate regarding more reasonable delays in credit reporting such as 60 or 180 days—despite potential challenges posed by these delays. The Medical Debt Relief Act, introduced by U.S. Sen. Jeff Merkely (D-Ore.), and co-sponsored by Senators Richard Blumenthal (D-Conn.), Elizabeth Warren (D-Mass.), Bob Menendez (D-N.J.) and Dick Durbin D-Ill.), would prohibit credit reporting for one year.

However, unlike the House bill, the Senate version clarifies that the legislation does not impact when a debt collector may engage in activities to collect or attempt to collect any debt owed or due or asserted to be owed.

ACA’s Efforts

ACA is actively discussing this legislation and the many flaws associated with it, with both Democrats and Republicans, including lawmakers who sit on the House Financial Services Committee and the Senate Banking Committee.

ACA sent a letter opposing the legislation to both the House and Senate last fall and launched a grassroots campaign in early 2020 to allow ACA members to engage directly with their members of Congress about how this legislation would impact them and the medical providers they serve (the letter is accessible on ACA’s advocacy page or here:  https://tinyurl.com/wlm77d8).

ACA is also working closely with other trade associations representing medical providers and credit reporting agencies to ensure that Congress understands the broad impact this issue could have on the ability to provide medical care to consumers, the accuracy of the credit reporting system, and the economy.

As the industry continues to face an unprecedented number of attacks in the 116th Congress, it is critical for ACA to educate lawmakers about flawed policies and to work with the Senate to ensure that House bills such as H.R. 5330 do not move forward in the Senate.

ACA members are encouraged to attend the Washington Insights Fly-In May 19-21, 2019, in Washington, D.C., to discuss this bill and other issues with lawmakers. Watch for updates on the Fly-In!


Trump Extends Comment Period for Proposed Rule on Price Transparency

Two days after Christmas, the Centers for Medicare and Medicaid Services extended the comment period for the “Transparency in Coverage Proposed Rule” published Nov. 27, 2019 by the Department of Health and Human Services, the Department of Labor and the Department of Treasury, a statement from CMS said. The proposed rule delivers on President Trump’s Executive Order on Improving Price and Quality Transparency.

The new comment period deadline was extended to Jan. 29, 2020 in response to public feedback and in consideration of the holiday season. According to the Trump Administration, the proposed rule is “a historic step toward putting health care price information in the hands of consumers, advancing the administration’s goal to ensure consumers are empowered with the information they need to make informed health care decision.”

Additional information may be obtained here:

https://tinyurl.com/sfctrat


The State of Reporting

Aside from the Fair Credit Reporting Act—the federal law governing credit reporting practices—state laws can impose additional restrictions on credit reporting. For example, some state laws limit the type of information that may be furnished, require consumer notifications, or restrict the reporting period.

Furnishers of information to consumer reporting agencies (CRAs) should be aware of and comply with any applicable state credit reporting requirements.  Some state laws place restrictions on the reporting of a particular type of debt. For instance, California, Colorado, Minnesota, Texas and Washington are all states that place certain restrictions on credit reporting medical debt.

California prohibits hospitals and its assignees from credit reporting certain patients that lack coverage or have high medical costs for nonpayment at any time prior to 150 days after initial billing. Colorado law prohibits data furnishers from credit reporting medical debts that are only partially paid by insurance, unless the health care provider sends the consumer a written notice that includes particular information, as required by statute, to the person responsible for the debt.

In Minnesota, some health care providers signed a written agreement with the Minnesota attorney general covering issues associated with litigation practices, garnishments, collection agencies and billing the uninsured in relation to attempts to collect medical debt. Texas prohibits consumer reporting agencies from furnishing consumer reports that include debts owed for out-of-network medical services.

Washington requires data furnishers to refrain from furnishing information about medical accounts until at least 180 days after the original obligation was received by the licensee for collection or by assignment.  State laws may require furnishers to provide consumers with a notice of furnishing negative information disclosure prior to, or shortly after, reporting adverse information to a CRA.

For instance, California and Utah require creditors and debt collectors to send consumers a written notice prior to or within 30 days after furnishing negative information concerning the consumer.  Further, state laws restrict when information can be furnished to a CRA.  For instance, Colorado prohibits “[c]ommunicating credit information to a consumer reporting agency earlier than 30 days after the initial notice to the consumer has been mailed, unless the consumer’s last-known address is known to be invalid.

These requirements demonstrate the need for furnishers to review state-specific credit reporting requirements to ensure compliance with credit reporting expectations. For a more in-depth look at state credit reporting laws, ACA members can review ACA SearchPoint™ document #1255, State Credit Reporting Laws.


After 15 Years, New Federal Overtime Rule Advances Salary Thresholds

Accounts receivable management industry companies may want to begin reviewing overtime and scheduling policies as a new overtime rule took effect Jan. 1, 2020.

The new rule, which makes 1.3 million workers eligible for overtime pay, raises the “standard salary level” from the currently enforced level of $455 per week to $684 per week (equivalent to $35,568 per year for a full-year worker), according to a news release from the Department of Labor.

Additional changes in the new rule include:

  • “Raising the total annual compensation requirement for “highly compensated employees” from the currently enforced level of $100,000 per year to $107,432 per year;
  • Allowing employers to use nondiscretionary bonuses and incentive payments (including commissions) paid at least annually to satisfy up to 10% of the standard salary level, in recognition of evolving pay practices; and;
  • Revising the special salary levels for workers in U.S. territories and the motion picture industry.”

Tips for abiding by the rule changes are available through the Department of Labor’s Small Entity Compliance Guide, accessible here: https://tinyurl.com/y366mrmv

Additional information may be obtained by accessing the U.S. Department


Court Dismisses TCPA Violation on Text Messages Reportedly Sent Using ATDS

A group of plaintiffs lost their argument in a case based on the ongoing district court debate about the definition of an automatic telephone dialing system (ATDS) and the capacity to randomly or sequentially generate numbers.

According to an article from Drinker Biddle Partner Michael Daly and Associate Vijayasri Aryama, “Court Holds That Text-Messaging System Must Be Able to Randomly or Sequentially Generate Numbers to Qualify as an ATDS,” the Northern District of Illinois entered a summary judgment against the plaintiffs in Smith v. Premier Dermatology “because it found the system at issue was not an ATDS.”

Plaintiffs in the case brought a putative class action against the defendants claiming they used an ATDS to send text messages about medical marketing communications without the consent of their clients’ customers, according to the article.

The plaintiffs based their argument on Marks v. Crunch San Diego after the defendants moved for summary judgment, specifically “to claim the TCPA’s statutory definition would include devices that could not generate random or sequential numbers, but could ‘dial stored numbers automatically,’” Daly and Aryama report.

However, the decision in ACA International v. FCC swayed the court in this case.  “Based on ACA International v. FCC, 885 F.3d 687 (D.C. Cir. 2018), the Smith Court determined that, although ‘[t]here is a certain allure to the conclusion in Marks,’ the 2003 FCC order ‘is no longer binding or in force’ and the TCPA’s statutory definition did not support Plaintiffs’ interpretation of an ATDS,” according to the article.

Ultimately, the court determined the text messages from the defendants did not qualify as a TCPA violation.  Read the complete article here: https://tinyurl.com/y5o8kw4o


Healthcare M & A Volume Declines in Q3

Health care merger and acquisition activity slowed compared with the second quarter, according to a statement released by HealthCareMandA.com.  The number of deals announced fell 13%, to 408, compared with the previous quarter and was 15% lower than the 478 deals announced in the same quarter in2018.

Combined spending in the third quarter totaled $51.5 billion, down 63% compared with the previous quarter’s extraordinary $139.1 billion. It was 65% greater than the $31.1 billion reported in the same quarter in 2018, according to HealthCareMandA.com.

Healthcare technology deals accounted for 33% of the third quarter’s deal volume. The eHealth sector was the busiest, posting 53 deals and making up 13% of the quarter’s total. Year-over-year, eHealth was the only one of the technology sectors to post an increase in deal volume, up 43% compared with the second quarter of 2018.

Combined spending among the technology sectors was more than $31.9 billion, the statement said. Additional information may be obtained here: https://tinyurl.com/y46yquzw


SBA Encourages CFPB to Mitigate Rule’s Impact on Small Business

The U.S. Small Business Administration (SBA) Office of Advocacy submitted comments on the Consumer Financial Protection Bureau’s proposed rule for the Fair Debt Collection Practices Act (Regulation F) in line with ACA International’s suggestions on consumer communications and disclosure notices and noting the significant impact it could have on small businesses.

Here are a few top-level comments from the SBA Office of Advocacy:

•     Several provisions of the rule will be particularly difficult for small debt collectors and require consideration of alternative approaches. These include the requirement of compliance with the E-Sign Act for electronic disclosures, the requirement of an itemized validation notice, liability for an attempt to collect a debt that is time-barred and requirements for retention of records.
•     The initial regulatory flexibility analysis states that larger collectors may already have some of the proposed provisions in place. The small debt collectors may not. Some of the provisions may require expensive changes to technology and additional training. Advocacy encouraged the bureau to give small entities additional time to comply if they cannot be exempted from the requirements of the proposed rule.
•     The bureau is prescribing the rules pursuant to its authority under the FDCPA, as well as the Dodd-Frank Act’s prohibitions on unfair, deceptive or abusive acts or practices (UDAAP). The UDAAP provisions create uncertainty for first-party creditors who are not supposed to be regulated by the proposal. Advocacy encouraged the bureau to limit the rule to the FDCPA.
•     The rule imposes a limit on the frequency of debt collection calls and provides a safe harbor for debt collectors who comply with the call caps. Because small entities do not usually make calls that exceed the limits in the proposal, Advocacy encouraged the bureau to exempt small debt collectors from the call limit caps.

The SBA Office of Advocacy’s comment letter and fact sheet may be accessed on the SBA’s website at www.sba.gov or here https://tinyurl.com/y2fmelcf. Additionally, ACA International submitted a 154-page comment letter available on its website at www.acainternational.org.


Trump Executive Order Opens Door for Hospital Price Transparency

The Centers for Medicare & Medicaid Services in July proposed a rule that would require hospitals to make pricing information publicly available. It is CMS’s position that the rule would increase competition by enabling patients to shop for health care that meets their needs and budgets.

The proposed rule follows President Donald Trump’s June Executive Order that “lays the foundation for a patient-driven health care system,” according to a press release issued by CMS. Trump’s executive order states, “Opaque pricing structures may benefit powerful special interest groups, such as large hospitals and insurance companies, but they generally leave patients and taxpayers worse off than would a more transparent system.”

Indeed, a statement released by Alex Azar, secretary of U.S. Department of Health and Human Services, noted that “healthcare leaders across the political spectrum have been talking about this need for real transparency for years. This proposal is now the most significant step any president has ever taken to deliver transparency and put patients in control of their care.”

The proposals for calendar year 2020 include changes that would require hospitals to take the following actions:

• Make public “standard charges” for all items and services provided by the hospital.
• Publish standard charges on the internet in a machine-readable file that includes common billing or accounting codes and a description of the item or service. This provides a common framework for comparing standard charges from hospital to hospital.
• Publish payer-specific negotiated charges for common shoppable services (e.g., x-rays, outpatient visits).

To ensure that hospitals comply with the requirements, the rule proposes new enforcement tools including monitoring, auditing, corrective action plans and civil monetary penalties of $300 per day. Additional information, including a list of public comments submitted, may be found on the federal register website at www.federalregister.gov or (https://tinyurl.com/y5zywwhs, comments were due Sept. 27, 2019) or at CMS’s website at www.cms.gov.

To read President Trump’s executive order, visit www.whitehouse.gov and search for “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First.”


Poll Shows a Majority of Americans Worry About Hackers

Given the constant news about data breaches that compromise personal information, it is no wonder that Americans are increasingly squeamish about being hacked. A new poll conducted by POLITICO and the Harvard T.H. Chan School of Public Health found that a majority of American adults worry about hackers gaining access to their Social Security number and credit card information.

When asked about which institutions they trust to protect their personal information, health care organizations such as doctor’s offices and hospitals ranked high, while most poll respondents expressed little trust that internet search engines and social media companies would keep their information safe, the study titled “Americans’ Views on Data Privacy & E-Cigarettes,” said.

More than half of adults said they were very concerned that unauthorized people may gain access to their Social Security number (63%) or their credit card number (57%). Among users of social media, 13% said they were very concerned that content they have posted on sites like Facebook, Twitter or Instagram in the past may come back to harm or embarrass them in the future, and 14% were somewhat concerned.

The poll also asked a series of questions about data privacy as it applies to health information or products that adults may have searched for privately online. Among adults who said they have searched for health information or health products online, 30% were very concerned that a company would use their search information to try to sell them medical products or treatments.

More than a quarter (28%) said they were very concerned such information may make it harder for them to get medical care, and one in four (25%) said they were very concerned that private search information may come back to hurt their chances of getting a job or health insurance, according to the study report.

Many Americans do not just search for health information online; they also obtain personal health information through patient portals. These secure websites give patients 24-hour access to their health information from anywhere in the world with an internet connection. The poll found that about a quarter (23%) of adults have ever set up a patient portal.

When asked what they use their patient portal for, the vast majority (81%) of adults said say they used theirs to see test results. More than half (59%) have used it to schedule an appointment, while 42% had requested a prescription refill and 40% received advice about a health problem using their patient portals. The study also showed that most respondents did not express a great deal of concern about potential hacking of patient portals.
About one in four (26%) patient portal users said they were very concerned that unauthorized people may be able to gain access to the private information contained in their portal. Meanwhile, 15% of users said they were not concerned about such a scenario at all.