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.


The State of Medical Collections

Medical debt accounts for one of the largest markets in collections.  While the Fair Debt Collection Practices Act regulates debt collection in general, the American Hospital Association (AHA), the national organization that represents and serves hospitals, health care networks and their patients, created a set of guidelines for member hospitals to follow regarding their billing and collection practices.

Other state hospital associations have implemented their own guidelines as well. ACA members who collect medical debt should be aware of both state and federal guidelines for hospital billing and collections.  The guidelines introduced by AHA include several objectives member hospitals are to set into practice to better serve their patients. The guidelines include substantive criteria under the following headlines:

  • Communicating Effectively
  • Helping Patients Qualify for Coverage
  • Ensuring Hospital Policies are Applied Accurately and Consistently
  • Making Care More Affordable for Patients with Limited Means
  • Ensuring Fair Billing and Collection Practices

In addition to the AHA guidelines, state hospital associations have adopted their own guidelines for their members to follow. While the state association guidelines tend to mirror those of the AHA, each has added its own specific language or requirements. Not to be left out, some states have even enacted legislation governing hospital billing practices.

A few states have robust legislation concerning hospital billing. One state’s hospital billing act requires each hospital in the state to establish a written policy about when and under whose authority patient debt is advanced for recovery efforts.

Any debt collectors who contract with the hospital must follow its policy. Among other things, debt collectors in this particular state must have a written agreement with the hospital for which they are collecting.  The law also limits the ability of the hospital and its agents to use wage garnishments or liens on primary residences as a means of collecting unpaid hospital bills.  Other states with hospital billing requirements are not as robust as the one previously mentioned.

These states have requirements that can include things such as giving notice to the patient as to whether the hospital deems her to be insured or uninsured, and the reason for such determination; not employing a third-party to use physical or legal means to compel the patient or responsible party to appear in court; and not furnishing a negative consumer report or filing suit until 120 days have passed.

It’s imperative that debt collectors who collect medical debt ensure they are aware of the state laws concerning hospital billing. ACA SearchPoint document #2805, State Hospital Billing and Collection Practices, provides an analysis of state and federal laws that deal with state medical billing and collection practices.


Texas Enacts Healthcare Measures Impacting Credit Reporting and Surprise Medical Billing

The state of Texas recently enacted new healthcare measures related to medical billing and credit reporting of out-of-network care. While neither of the bills are specifically targeted at collection agencies, there are some implications regarding the billing of consumers for out-of-network care as well as the reporting of debts related to out-of-network care.

Senate Bill 1037 prohibits a consumer reporting agency from furnishing consumer report information related to “a collection account with a medical industry code, if the consumer was covered by a health benefit plan at the time of the event giving rise to the collection and the collection is for an outstanding balance, after copayments, deductibles, and coinsurance, owed to an emergency care provider or a facility-based provider for an out-of-network benefit claim. . .”

Though the bill does not technically prohibit a data furnisher from reporting debts arising from out-of-network care, debt collector’s may nevertheless want to consider refraining from reporting such debts in order to avoid claims by devious consumer attorneys that even furnishing such information to a CRA violates the FDCPA or state law. Senate Bill 1037 is effective immediately.

Senate Bill 1246 prohibits a nonnetwork physician, provider “or a person asserting a claim as an agent” from billing a patient covered out of network and receiving emergency care in any amount greater than the patient’s responsibility under the patient’s health care plan, including applicable copayment, coinsurance, or deductible.

The new law also requires a health maintenance organization to provide written notice of billing prohibitions in each explanation of benefits provided to an enrollee or physician or provider in connection with a health care service that is subject to the prohibitions. Notably, the bill allows the attorney general to bring a civil action against any individual or entity believed to be violating a law prohibiting balance billing. Senate Bill 1246 takes effect on Sept. 1, 2019.

Other Debt Collection Measures

ACA members should also be aware that Texas recently enacted House Bill 996, which requires certain notices to be provided when collecting debts that are beyond the applicable state statute of limitations. Bill 996 takes effect on Sept. 1, 2019.

For more information on those requirements, members can review ACA SearchPoint #1119, Statute of Limitations:

Collecting Out-of-Statute Debts.  ACA recommends members review these measures with clients and their own legal counsel to determine if any changes are required to current billing or credit reporting practices.

To track legislation in Texas, visit https://capitol.texas.gov/Texas


JAMA Study Finds 36% of Virginia Hospitals Garnishing Wages Over Unpaid Bills

Not every hospital sues over unpaid bills, but a few sue a lot, according to an article published by NPR.  While admitting there “are no good national data on the practice,” NPR writer Selena Simmons-Duffin notes journalists have reported on hospitals suing patients all over the United States– from North Carolina to Nebraska to a hospital in Missouri that sued 6,000 patients over a four-year period.

Simmons-Duffin’s article titled, “When Hospitals Sue for Unpaid Bills, It Can be ‘Ruinous’ for Patients,” focuses on a study published by JAMAThe Journal ofAmerican Medical Association that looks into 2017 Virginia court records on completed warrant-in-debt lawsuits filed by hospitals resulting in garnishment of a patient’s wages.

The JAMA study, led by Martin A. Makary, MD, MPH, of Johns Hopkins University in Baltimore, identified 20,054 warrant-in-debt lawsuits and 9,232 garnishment cases in 2017. Garnishing was conducted by 48 of 135 Virginia hospitals (36%), of which 71% were nonprofit and 75% urban, compared with 53% nonprofit and 91% urban among hospitals that did not garnish, according to the study titled, “Prevalence and Characteristics of Virginia Hospitals Suing Patients and Garnishing Wages for Unpaid Medical Bills.”

“Thirty-six percent of Virginia hospitals garnished wages in 2017, with a small number of hospitals accounting for most cases,” the Johns Hopkins researcher said. “Some characteristics suggest that hospitals with greater financial need (nonprofit, lower annual gross revenue) may be pursuing debt collection to the final stage of garnishment.”

The most common employers of those having wages garnished were Walmart, Wells Fargo, Amazon and Lowes, accounting for 8% of patients whose wages were garnished, the study said. This point was central to Simmons-Duffin’s article, which focused heavily on Mary Washington Hospital, a Fredericksburg, Va.-based hospital that’s part of the Mary Washington Healthcare network. (The JAMA study found that five hospitals accounted for more than half of the lawsuits, with Mary Washington suing the most.)

In response to NPR’s report, Mary Washington officials noted that lawsuits are rare (less than 1% of their patients go to litigation). Lisa Henry, communications director for the health care system, said: “It’s important to us, as a small community, and a safety net hospital, that we’re doing everything we can for our patients to avoid aggressive collections.”

Mary Washington has a months-long process for trying to reach patients before it takes legal action. “By phone, by mail, by email — any access point we’re given from them when they register.  “Unfortunately, if we don’t hear back from folks or they don’t make a payment we’re assuming that they’re not prepared to pay their bill, so we do issue papers to the court.

Because court records are public, Mary Washington officials noted that they are subject to more scrutiny than hospitals that use collection agencies.  “We’re really unclear as to why Mary Washington Healthcare in particular has become the face of this,” Henry says. “I don’t think we’re alone — all hospitals are struggling with, ‘How do we collect appropriately from our patients to stay open as a safety net hospital?’”

Meanwhile, Makary, the corresponding author on the JAMA study who is also a surgeon at Johns Hopkins, was so “outraged” over Mary Washington’s efforts to recoup unpaid debt that he formed an advocacy campaign to encourage the hospital to “stop suing low-income patients for bills that they simply can’t afford,” the NPR article stated.

In defense of Mary Washington, Henry noted that most patients who are eligible sign up for financial assistance and payment plans, the article said. According to its website, [Mary Washington Healthcare’s] “not-for-profit status drives us to be the kind of organization that provides care to those in need, regardless of their ability to pay. We provide significant financial assistance.”


Senate Health Committee Votes to Reduce Health Care Costs

Before heading off for the Fourth of July holiday, the Senate Health, Education, Labor and Pensions Committee approved legislation that ends surprise billing, creates more transparency and increases competition to reduce prescription drug costs. The bill, known as the “Lower Health Care Costs Act” was approved in a 20-3 vote.

“Altogether, this legislation will help to lower the cost of health care, which has become a tax on family Budgets and on businesses, on federal and state governments,” said Committee Chairman Lamar Alexander (R-Tenn.).

“A recent Gallup poll found that the cost of health care was the biggest financial problem facing American families. And last July, this committee heard from Dr. Brent James, from the National Academies, who testified that up to half of what the American people spend on health care may be unnecessary.”

Additional information may be viewed on the Committee’s website accessible here: www.help.senate.gov


Unforeseen Out-of-Network Charges Cause Concern Amongst Consumers

About 1 in 6 Americans were surprised by a medical bill after treatment in a hospital in 2017 despite having insurance, according to a study published in June. On average, 16% of inpatient stays and 18% of emergency visits left a patient with at least one out-of-network charge. Most of those came from doctors offering treatment at the hospital, even when the patients chose an in-network hospital, according to researchers from the Kaiser Family Foundation. Its study was based on large employer insurance claims.

The research also found that when a patient is admitted to the hospital from the emergency room, there’s a higher likelihood of an out-of-network charge. As many as 26% of admissions from the emergency room resulted in a surprise medical bill. “Millions of emergency visits and hospital stays left people with large employer coverage at risk of a surprise bill in 2017,” the authors wrote.

The researchers got their data by analyzing large-employer claims from IBM’s MarketScan Research Databases, which include claims for almost 19 million individuals. Surprise medical bills are top of mind for American patients, with 38% reporting they were “very worried” about unexpected medical bills. Surprise bills don’t just come from the emergency room.

Often, patients will pick an in-network facility and see a provider who works there but isn’t employed by the hospital. These doctors, from outside staffing firms, can charge out-of-network prices. “It’s kind of a built-in problem,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation and an author of the study. She said most private health insurance plans are built on networks, where patients get the highest value for choosing a doctor in the network. But patients often don’t know whether they are being treated by an out-of-network doctor while in a hospital.

“By definition, there are these circumstances where they cannot choose their provider, whether it’s an emergency or it’s [a doctor] who gets brought in and they don’t even meet them face-to-face.” The issue is ripe for a federal solution. Some states have surprise-bill protections in place, but those laws don’t apply to most large-employer plans because the federal government regulates them.

“New York and California have very high rates of surprise bills even though they have some of the strongest state statutes,” Pollitz said. “These data show why federal legislation would matter.” Consumers in Texas, New York, Florida, New Jersey and Kansas were the most likely to see a surprise bill, while people in Minnesota, South Dakota, Nebraska, Maine and Mississippi saw fewer, according to the study. Legislative solutions are being discussed in the White House and Congress.


Balance it Out

Working with consumers to explain and help resolve medical bills in collections is a complex process for accounts receivable management companies and their health care provider clients.  Add in the mix unexpected out-of-network charges on a consumer’s bill and all parties involved face challenges to find a solution.

State legislatures started to tackle the issue, known as balance billing, to prevent these charges from reaching the consumer after their bill is processed by a provider and insurance company. Bipartisan debate continues at the federal level to enact laws prohibiting balance billing.

A ‘balance bill’ is a term that refers to any time a consumer’s insurance pays part of the bill, yet they are responsible for paying the balance; and states with laws on balance billing indicate the circumstances when it is legal, according to The Commonwealth Fund.

Educate and Work Together

As lawmakers focus on the issue of balance billing at the state and federal level, it’s best for collection agencies in business partnerships with health care providers to learn together with the goal to help patients through the process.

In California, an amendment to the state’s health and safety code (added sections 1371.30, 1371.31 and 1371.9) AB 72, authored by Assemblyman Rob Bonta, D-Alameda, took effect July 1, 2017.  AB 72 applies to non-emergency care that is provided at an in-network facility but performed by a physician who is out-of-network with the patient’s insurance plan.

“The obvious problem that this has created is that it is difficult for the provider to know if the patient was in-network at the facility or if the services were part of some non-emergency treatment that would require AB 72 to be applied,” according to Courtney Reynaud, president of Creditors Bureau USA in Fresno, California, which works in medical collections.

Reynaud, who is also president of the California Association of Collectors Inc., said after the legislation took effect some provider clients stopped referring accounts to collection with charges that could potentially fall under AB 72.  Oftentimes, they had no mechanism to determine if the services were emergency or non-emergency and if the services were provided at an in-network facility.

Reynaud recommends staying informed on legislative issues and compliance through state and national medical associations such as the California Medical Association and Medical Group Management Association. Balancing Compliance California’s legislation is different than laws in other states and proposed bills at the federal level in that it doesn’t cover charges as a result of a patient’s emergency services.

For example, in Florida, legislation in effect since July 2016 protects patients from out-of-network charges at an in-network facility in emergency situations.  Before the legislation took effect, Matt Kiefer, chief officer of information, compliance and development at The Preferred Group of Tampa in Tampa, Florida, said his agency received medical accounts from unexpected charges due to balance billing.

“Covered charges, noncovered charges, coupled with high deductibles and copays can not only be confusing, but upsetting and only exacerbates the issue when out of network charges and balance billing

are allowed,” Kiefer said. “Legislation like HB 221 in Florida to prevent surprise charges helps the patient in an already uncomfortable position.”

If there is pending legislation in your state, or to stay informed about the topic at the federal level, Reynaud also suggests hosting a webinar for clients or coordinate office training for your provider client’s staff.  “The bottom line is to continue to train collectors to be empathetic when working with consumers with medical debt, especially when it comes to medical debt from surprise medical bills if there is not legislation in your state and the charges are from out-of-network providers.”


Million-Dollar Lawsuit Results from Insurer Sending Payment to Patients-Not Doctors

In a report released by CNN, a woman received nearly $375,000 from her insurance company over several months for treatment she received at a California rehabilitation facility. A man received more than $130,000 after he sent his fiancée’s daughter for substance abuse treatment.

Those allegations are part of a lawsuit winding its way through federal court that accuses Anthem and its Blue Cross entities of paying patients directly in an effort to put pressure on health care providers to join their network and to accept lower payments, the article revealed.

The insurance giant is accused of sending more than $1.3 million in payments to patients -- money, the suit claims, that is owed to the facilities that treated people with addiction and mental health problems.

The suit by Sovereign Health highlights part of an ongoing war between insurance companies and providers over payment and billing issues, one that puts the patient right in the middle of the fighting by sending payments straight to patients after they seek out-of-network care.

Patients are supposed to send the money on to providers. Many times, they do; other times, they don’t, according to CNN.

More information: https://cnn.it/2NA0P0U


HHS Payment Model Designed to Meet Beneficiaries’ Emergency Needs

Supporting ambulance triage options aims to allow beneficiaries to receive care at the right time and place.  Earlier this year, the U.S. Department of Health and Human Services (HHS), Center for Medicare and Medicaid Innovation (Innovation Center), which tests innovative payment and service delivery models to lower costs and improve the quality of care, announced a new payment model for emergency ambulance services.   It aims to allow Medicare Fee-For-Service (FFS) beneficiaries to receive the most appropriate level of care at the right time and place with the potential for lower out-of-pocket costs, a press statement released by HHS said.

The new model known as the Emergency Triage Treat and Transport (ET3), will make it possible for participating ambulance suppliers and providers to partner with qualified health care practitioners to deliver treatment in place (either on-the-scene or through telehealth) and with alternative destination sites (such as primary care doctors’ offices or urgent-care clinics) to provide care for Medicare beneficiaries following a medical emergency for which they have accessed 911 services.

In doing so, the model seeks to engage health care providers across the care continuum to more appropriately and effectively meet beneficiaries’ needs. Additionally, the model will encourage development of medical triage lines for low-acuity 911 calls in regions where participating ambulance suppliers and providers operate. The ET3 model will have a five-year performance period, with an anticipated start date in early 2020.

The ET3 model encourages high-quality provision of care by enabling participating ambulance suppliers and providers to earn up to a 5 percent payment adjustment in later years of the model based on their achievement of key quality measures. The quality measurement strategy will aim to avoid adding more burden to participants, including minimizing any new reporting requirements.

Qualified health care practitioners or alternative destination sites that partner with participating ambulance suppliers and providers would receive payment as usual under Medicare for any services rendered. The model will use a phased approach through multiple application rounds to maximize participation in regions across the country.

To ensure access to model interventions across all individuals in a region, CMS will encourage ET3 model participants to partner with other payers, including state Medicaid agencies.  CMS anticipates releasing a Request for Applications this summer to solicit Medicare-enrolled ambulance suppliers and providers. In Fall 2019, to implement the triage lines for low-acuity 911 calls, CMS anticipates issuing a Notice of Funding.

There is an opportunity for a limited number of two-year cooperative agreements, available to local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic locations where ambulance suppliers and providers have been selected to participate. For more information, please visit: https://innovation.cms.gov/initiatives/et3/ and https://bit.ly/2Ii9ZQD.


How Insurance Coverage Impacts Consumers’ Ability to Pay

New data on health insurance in the U.S. from The Commonwealth Fund reflects quality of coverage and the impact of coverage levels on consumers’ ability to pay medical bills and access care.

Among the findings in the Biennial Health Insurance Survey, The Commonwealth Fund reports that consumers who are “underinsured,” meaning they carry high health plan deductibles and out-of-pocket medical expenses compared to their income, are more likely to have challenges paying their medical bills or avoid medical care because of the expense.

Twenty-nine percent of insured adults qualified as “underinsured” in 2018, an increase from 23 percent in 2014.  “U.S. working-age adults are significantly more likely to have health insurance since the ACA [Affordable Care Act] became law in 2010. But the improvement in uninsured rates has stalled.

In addition, more people have health plans that fail to adequately protect them from health care costs, with the fastest deterioration in cost protection occurring in employer coverage,” said Sara Collins, lead author of the study and The Commonwealth Fund vice president for health care coverage and access, in a news release.

The survey offers a big-picture look at consumers’ health insurance, including the quality of their coverage, in 2018.

Key findings in the survey include:

Twenty-eight percent of U.S. adults who have health insurance through their employer were underinsured in 2018, an increase from 20 percent in 2014.

Consumers who purchased plans on their own through the individual market or the marketplaces were the most likely to be underinsured, with 42 percent reporting a lack of adequate coverage in 2018.

Forty-one percent of underinsured adults reported they held off on care they needed because of the expense, compared to 23 percent of consumers with “adequate insurance coverage.”

And, 47 percent of underinsured adults said they had medical bill and debt problems, compared to 25 percent of consumers who are not underinsured reporting these challenges.

More information: https://bit.ly/2GAEZsT


Senator Chuck Grassley to IRS: How Many Hospitals Comply with 501(r) Requirements?

In an ongoing effort to evaluate nonprofit hospitals required to follow Section 501 (r) of the Internal Revenue Code focused on charity care, U.S. Sen. Chuck Grassley, R-Iowa, has requested data on the number of hospitals that are in compliance with the requirements from the Internal Revenue Service in the last year.

Hospitals subject to 501 (r) must complete a community health needs assessment, meet financial assistance policy requirements, adhere to limitations on charges and follow billing and collection practices.

The IRS’ 501 (r) requirements for nonprofit hospitals, in effect on Dec. 29, 2015, marked a complex change for the health care collections industry, health care providers, patients and more.  Grassley has been a watchdog for the program for several years, prompting a recent letter to IRS Commissioner Charles Rettig with the request for information on nonprofit hospitals’ compliance.

Specifically, Grassley is seeking information about whether tax-exempt hospitals are meeting the statutory requirements laid out in section 501 (r) of the Internal Revenue Code, according to a news release.  “Making sure that tax-exempt hospitals abide by their community benefit standards is a very important issue for me,” he said.

In February 2018, Grassley and former Senate Finance Committee Chairman Orrin Hatch, R-Utah, pressed the IRS for information on enforcement practices and compliance data on nonprofit hospitals.  Grassley has continually urged greater compliance among nonprofit hospitals.  On an annual basis, according to Grassley’s letter, the IRS reviews about one-third of the approximately 3,000 tax exempt hospitals for compliance.

The letter requests an update on those reviews, including those that were resolved upon contact with the hospital, required a compliance check or follow-up investigation as well as how many hospitals were not in compliance with these specific requirements:

Community Health Needs Assessment

Financial Assistance Policy Requirements

Requirements on Charges Billed to Patients

Billing and Correction Policies

Read more on Senator Grassley’s request here: https://bit.ly/2GOyWlf  What is your experience as a hospital required to comply with 501 (r) or as a collection agency working on revenue cycle management with these hospitals? Share your thoughts with ACA International’s Communications Team at comm@acainternational.org, Attn: Katy Zillmer.

Harry Strausser, ACA International’s Education and Membership Development Director, and Irene Hoheusle, vice president of collections and education at Account Recovery Specialists Inc., recently discussed health care collections trends, including 501 (r), in an episode of ACA Cast.


Patients Prefer Payment Plans for Medical Bills

As out-of-pocket health care costs continue to increase for consumers, more prefer payment plans to manage their medical bills, according to the “Changing Landscape of Health Care Payment Plans” report, produced by PYMNTS in collaboration with Flywire. Data on the report is based on a survey of 2,837 patients who checked into a hospital or emergency room in the previous year.

Key findings include:

57 percent of respondents would prefer a payment plan offered before service or at the time of service with their health care provider.

35.5 percent would prefer a payment plan offered at the time they receive their first bill.

Just 6.9 percent choose a phone call from their provider to ask for a plan.

There is a direct relationship between a patient’s increased out-of-pocket payments and the chance they will sign up for a payment plan:

38.9 percent of respondents used payment plans to manage out-of-pocket expenses ranging from $50 to $250.

When costs topped $1,000, 51.4 percent opted for payment plans.  Payment plan fees influence how patients make decisions connected to payment plans, for example:

33.7 percent choose shorter terms to reduce fees.

17 percent pay balances in full to avoid fees.

25 percent say fees have no influence on their decision on how to pay.

“The study offers important insights for hospitals and health systems seeking to optimize their revenue cycle practices and payment plan strategy, as well as to improve payment behavior without jeopardizing the relationship between patient and provider,” John Talaga, executive vice president, Flywire, said in a news release on the study.  More information: https://bit.ly/2CDJMpH


Why a Patient Friendly Billing and Payment System Matters

To boost your bottom line, it may pay to consider patient consumerism when dealing with your patients. Because when a patient schedules a visit for medical care, they’re not simply thinking about the quality of care. They’re thinking about the value they’re getting from the visit, even if they have medical insurance coverage. Here are some of the realities patients and care providers are facing in regards to patient consumerism:

In the past decade, high-deductible health plans have become the norm for millions of Americans, meaning your patients’ out-of-pocket expenses cover the gamut, from $1,350 for individuals to $13,300 for families.  That means even with tools like health savings accounts, patients are more watchful than ever over their health care dollars.

Some of the struggling patients are young: Patients in their late 20s were more likely to have medical debt in collections than older patients, despite the fact they were less likely to use medical services, according to a 2018 study published in Health Affairs. Another surprise: Half the accounts in collections were for less than $600.

Three-quarters of a percent of health care providers saw a rise in patient responsibility for payments in 2015, according to a report in Rev Cycle Intelligence. And health care providers aren’t recovering the full balance from the patient but recouping 50-70 percent of the billable amount.  To work within these new realities, health providers can take proactive steps to make access to medical care more patient-friendly, and one area of focus could be in the realm of billing and collections.

Better front-end procedures: When a patient goes about their daily lives, they have become accustomed to completing many transactions online or with a smartphone app, whether they want to apply for a new job, shop for necessities, order food, get a ride, buy concert tickets, or transfer funds. When a patient wants to see a doctor, patients are still picking up the phone to book appointments and filling out paper forms in the waiting room.

Offering an online scheduling system is a more convenient way for patients to book (and reschedule) appointments. Giving patients the ability to fill out electronic intake forms can reduce data entry errors, speed up the billing process and ensure that your billing department has accurate information about the patient.

Communicate about costs: From a patient’s perspective, medical costs are notoriously difficult to plan for. Health Care providers can help patients prepare by informing them of their payment responsibility upfront. Some providers even supply chargemaster prices, with a strong caveat that the amount could change after their insurer processes the visit.  When patients gain the ability to plan for these expenses, it can reduce stress in patients and build trust.

Smarter collections: The final step in the patient interaction is billing. Accepting online credit card payments makes it easy, convenient and safe for patients to pay their bills. When patients are late with payments, good communication is key to recovery, especially if the phone calls and letters help patients understand their options to catch up on their late bills. Finally, treat past-due patients with respect and compassion. When it comes time to send these accounts to a collection partner, experience and professionalism count.

Health care is a major expense for patients, which is why it’s important for clinics and practices to demonstrate the care just as much for a patient’s financial health as they do their physical health.

Brian Eggert is a business development specialist and writer for IC System. Moreinformation: https://bit.ly/2AZ010l


Employer-Based Insurance Premiums Create Growing Burden for Families

A growing number of consumers are doling out more of their paychecks for health care premium contributions through their employer insurance plans, according to The Commonwealth Fund Report “The Cost of Employer Insurance is a Growing Burden for Middle Income Families.”

“The cost of employer health insurance premiums and deductibles continues to outpace growth in workers’ wages. This is concerning because it may put both coverage and health care out of reach for people who need it most—people with low incomes and those with health problems,” said Sara Collins, lead author of the study and Commonwealth Fund vice president for health care coverage and access, in a news release.

“Policies that would reduce health care burdens on employees include fixing the Affordable Care Act’s family coverage glitch, requiring employers to exclude some services from the deductible and increasing the required minimum value of employer plans.”

Key findings from The Commonwealth Fund include:

In 2017, the average employee premium costs for single and family insurance plans totaled almost 7 percent of the median income in the U.S., compared to 5 percent in 2008.

Combined, the total expense from premiums for workers and “potential spending” on deductibles for single and family insurance plans increased to an annual amount of $7,240 in 2017.

Employees’ contributions for insurance premiums also increased.  “Between 2016 and 2017, employee premium contributions rose by 6.8 percent to $1,415 for single-person plans and by 5.3 percent to $5,218 for family plans.”

See more information from the report here https://bit.ly/2PV28ah and in Data Watch.


Healthcare Providers Report Status of Revenue Cycle Management

Recent research shows some hospitals are lagging in implementing Revenue Cycle Management (RCM) solutions and consider outsourcing services only as a short-term solution.  “Twenty-six percent of all U.S. hospitals still do not have a viable, effective RCM solution in place, despite all the evidence of their positive impact on revenue, bottom line and efficiency,” according to a news release from Black Book Market Research LLC, which conducted the survey.

Respondents evaluated their technology services and solutions for the survey and of the “1,600 RCM modernization-delinquent hospitals,” according to the news release, 82 percent said they plan on making “value-based reimbursement decisions in 2019 without an advanced software implementation or outsourced partner.”

Results from a 2012 survey on RCM revealed that 35 percent of hospitals did not have an RCM strategy. The decline to 26 percent, “does indicate that there have been workable RCM IT plans adopted and new systems implemented by about 400 hospitals over the past six years.”

While a majority of respondents said they plan to implement advancement in RCM in-house, 85 percent also reported they would work with an outside firm for short-term direction, according to the news release.

ACA International members interviewed for the January issue of Pulse said RCM is changing significantly based on technology and third-party agencies can provide valuable plan options to meet providers’ and patients’ needs.  (Read more industry insight on RCM in January issue of Pulse here https://www.acainternational.org/pulse.)

Additional findings from the Black Book Market Research Survey include:

Nearly 70 percent of providers said it takes a minimum of one month to collect a full balance from a patient.

They also seek to prevent claim denials through RCM.

However, challenges include staffing resources for RCM software and reimbursement.

More information: https://bit.ly/2T1UbSE


Senators Cosponsor Legislation to End Surprise Medical Bills; Lower Healthcare Costs

Two U.S. senators recently introduced companion legislation that would help consumers manage health care costs and stop unexpected medical bills. U.S. Sen. Jeanne Shaheen, D-N.H., introduced the Reducing Costs for Out-of-Network Services Act of 2018 in October to “combat escalating out-of-pocket healthcare costs for uninsured patients and for patients in the individual health insurance market who receive out-of-network care,” according to a news release.

Cosponsor U.S. Sen. Maggie Hassan, D-N.H., introduced companion legislation to help end surprise medical bills for consumers as a result of receiving care they didn’t realize was considered out-of-network. “Shaheen’s legislation protects patients who are uninsured or in the individual health insurance market, while Hassan’s legislation protects patients with employer-sponsored health plans,” according to the news release.

“The bills that Senator Hassan and I are introducing would help fix chronic problems in our health care system by lowering costs for patients and increasing access to health services,” Shaheen said.  Shaheen’s bill, would cap the amount that hospitals and physicians could charge uninsured patients and out-of-network patients who have individual market coverage, according to the news release.

The Reducing Costs for Out-of- Network Services Act, it states, would:

Significantly reduce out-of-pocket costs for patients who have individual market health insurance and receive care from out-of-network hospitals and physicians;

Substantially reduce out-of-pocket costs for uninsured patients who could otherwise be charged very high “full charge” prices for hospital and physician services; and

Reduce premiums for individual market health plans by improving individual market insurers’ ability to hold down negotiated provider payments and costs for in-network care.

Shaheen is also cosponsoring Hassan’s legislation, the No More Surprise Medical Bills Act of 2018 that will help “protect patients with medical emergencies from surprise billing by prohibiting hospitals and providers from charging more than the in-network amount.”

Hospitals would also be required to notify patients in non-emergency situations if their services are is out-of-network and obtain their consent before providing care.  In November, Hassan highlighted the importance of her legislation during a hearing with the Senate Health, Education, Labor Pensions Committee focused on health care costs.

“Studies have shown that nearly 1 in 5 visits involves care from providers who are out-of-network, and non-emergency situations often result in surprise medical bills as well,” Hassan said.  More information: https://bit.ly/2PfE0yY