CMS Explores Consolidated Payment System

Over the last several years, CMS has worked with the Medicare Payment Advisory Committee to streamline payments for a number of patient services and procedures. Each group has proposed changes to Medicare billing that, if adopted, could streamline and reduce annual healthcare spending for the program.

The current payment system allows for differing payments for the same service depending on where and by whom it was performed. Hospital outpatient departments, for example, receive a higher payment than a physician’s office for the same procedure. However, differentials are also present when measuring payments received by the same physician for the same procedure based on how it was coded.

Several elements contribute to the billing differences that CMS and MedPAC hope to eliminate, including packaged versus separate payments; where providers choose to perform services (and patients choose to receive them); and different methods of weighing payments between different facilities.

Proposed changes include updates to this year’s physician fee schedule and limiting billing to either physician rates or hospital rates. The larger question this creates, however, is which system is the best to determine payment rates at all

A site-neutral payment program is slowly developing: beginning in 2016, long-term care hospital pay rates will shift to align with existing inpatient PPS rates. In the meantime, both CMS and MedPAC continue to identify inconsistencies in payments and potential solutions for them.

In the last 15 years, PRN Funding has provided comprehensive alternative funding solutions for healthcare companies. To learn more about the benefits of healthcare factoring and medical receivables factoring, contact PRN Funding today.

Many Employers to Offer “Skinny” Insurance Plans in 2015

According to a survey by the National Business Group released earlier this month, as many as 16 percent of large employers will seek to minimize their healthcare costs next year by offering low-benefit, or “skinny”, plans to their employees.

The companies that will offer skinny plans versus fully ACA-compliant plans were not identified by their industries in the survey; however, traditionally companies with a high percentage of low-wage employees have taken the most advantage of those plans. Skinny plans are considered “minimum essential coverage” by ACA standards by virtue of being employer-provided, but are often lacking other key features that roll into that distinction.

Skinny plans allow employers to avoid a penalty by simply offering a plan, and purchasing one allows the employee to avoid individual mandate penalties by enrolling in a healthcare plan with lower premiums. Unfortunately, the benefits to individuals end there. Some plans cover nothing but preventive care, and all plans feature exorbitant deductibles that can make actually seeking care an unaffordable option should the employee ever require it.

Another significant blow to employees at these companies is that they will not qualify for subsidies to purchase better coverage on state or federal exchanges because their employer offers an ACA-compliant plan, regardless of whether they enroll in that plan or not.

The effect of skinny plans on healthcare costs to providers and vendors remains to be seen.

PRN Funding offers a variety of customized healthcare factoring solutions to healthcare vendors in order to cover operating costs – including providing insurance. To learn more about healthcare factoring or medical receivables factoring and apply for service, contact PRN Funding today.

Medicare Payments Concentrated in Few Specialties

Medicare’s 2012 payments to providers were largely concentrated in a few specialties, according to recent disclosures.

An analysis of federal physician billing data illustrates that 14 percent of disbursements went to the top one percent of physicians, with the bulk of payments concentrated in oncology and ophthalmology.

Without information about individual patient cases, though, physicians argue that the raw data lacks the necessary context to be applied effectively. Billing data was off-limits from 1979 until 2013 due to an injunction filed by the AMA for this reason, among others. Many physicians are also concerned that patient and physician privacy could be at risk now that billing data is available.

That oncology and ophthalmology top the list of highest-paid specialties is unsurprising given that Medicare patients aged 65 and older are their primary demographic. Much of the money paid out to ophthalmologists covered many common eye drugs that the physicians purchase up front and prescribe for little profit. On the other hand, last year CMS reduced payments for cataract surgery to reflect updates to the procedure.

Economists hope to use billing data to identify physicians who perform high-revenue procedures with little value to the patient in order to increase their billing. The greatest concern posed by the information as presented is the possibility that some seniors may go through unnecessary treatment simply for a higher paycheck. The AMA cautions that the data released do not illustrate the value of services provided, however.

PRN Funding is a leading provider of invoice factoring services to healthcare providers. To learn more about healthcare factoring, visit our Web site and fill out an easy online application.

Enhanced by Zemanta

ACA Changes Mental Health Treatment

Mental health is a critical but oft-ignored component of health care. Patients in need of mental health treatment face the double blow of social stigma and lack of insurance coverage, making effective treatment an unaffordable option. Provisions of the Affordable Care Act will make mental health treatment more accessible than before, with the potential to completely overhaul the current mental health system.

Insurers have traditionally excluded mental health coverage from their health plans, citing mental issues as a pre-existing condition. With costs as high as $150 or more for a single office visit – not counting costly prescription medication – many more patients are forced to go without care in lieu of paying those costs out of pocket.

The ACA, however, includes mental health in its list of ten Essential Health Benefits and will require insurers to offer coverage on par with other medical and surgical benefits. This will not only benefit millions of uninsured Americans with mental health concerns, but also the many insured Americans whose policies do not currently provide equal mental health coverage.

Mental health providers will face a number of challenges in January when the ACA is fully implemented. One major challenge, of course, is the ratio of available providers to the estimated number of newly enrolled patients they will see. A care gap may persist as providers scramble to provide services to as many as possible.

In addition, the inclusion of insurers as payers for mental health care adds a level of complexity to providing care that will drive many solo practitioners into group practices. Solo therapists who collect cash are able to charge higher fees and often save costs associated with billing software and office space, choosing instead to work out of their homes. However, accepting insurance will require them to get up to speed with medical billing and coding and to accept lower fees per session as part of their agreement with insurers.

A larger practice offers cost-sharing benefits in which many professionals can go in together for expensive software and real estate, though working with insurance companies can take away from the autonomy that many therapists currently enjoy. Another possibility, however, is joining a traditional medical practice to create an integrated approach to healthcare. Having a mental health professional in a group practice gives general health providers another diagnostic option that will allow them to provide better – and less costly – care.

Mental health providers considering a shift in their practice can ease the burden of insurance collections with medical receivables factoring. Factoring allows you to turn your claims into immediate cash that you can invest in the necessary software, real estate, and logistics to continue providing quality treatment to your patients. PRN Funding can get you started in a medical receivables factoring program that fits your needs – contact us today to learn more.

Enhanced by Zemanta

September Layoffs Largely Concentrated in Healthcare

The once recession-proof healthcare industry took a large hit in September, reporting more layoffs than any other industry for the month.

Hospital layoffs

Healthcare providers let go more than 8,000 employees, including administrative staff as well as doctors and nurses, in an ongoing effort to reduce costs. Some notable reductions are Vanderbilt University Medical Center’s 1,000-employee cut and Cleveland Clinic’s 3,000-employee buyout plan. Reductions are projected to continue into next year, cutting into the past year’s gains in private hospital employment.

The layoffs are a response to a variety of funding cuts and changing hospital conditions, including new reductions established by the Affordable Care Act. Medicare and Medicaid reimbursements in particular have fallen sharply due to sequestration and additional penalties associated with the Hospital Readmissions Reduction Program, which cuts reimbursement to hospitals with excessive readmissions for applicable conditions. Other factors include:

  • Research funding from the National Institutes of Health was cut five percent due to sequestration;
  • Increasing numbers of patients are aging into Medicare, which reimburses at lower rates than private insurance;
  • Despite the ACA’s expansion of Medicaid, 26 states have chosen not to expand the program and accept greater funding (Vanderbilt cites this as a primary cause of their cuts);
  • Private insurance policies are paying out lower amounts, passing costs on to patients with higher deductibles and co-insurance;
  • Inpatient stays have shortened since the recession began, decreasing in length by four percent from 2007-2011.

Healthcare consultants, however, point out that hospital layoffs are a shortsighted solution that many facilities will have to reverse as more patients take advantage of their access to affordable healthcare and seek treatment they may have otherwise eschewed.

There are alternative solutions for facilities looking to shore up their cash flow. Medical receivables factoring gives hospitals immediate access to cash that they can use to meet their expenses without cutting employees they will likely need to call back in the next few months. PRN Funding has more than a decade of experience in the healthcare industry and can help meet the unique needs of providers. Apply today to learn more and get the cash ball rolling.

Enhanced by Zemanta

Up-Front Deductible Payments on the Rise

Need to see the doctor? Be prepared to pay at the door.

Up-front deductible payments

The Affordable Care Act has prompted a shift toward low-premium, higher-deductible health plans, both employer-provided and available on the exchange. In order to collect as much of the out-of-payment cost as possible, many health providers have responded by requiring up-front payment from patients before receiving nonemergency treatment. Insured patients at these facilities must pay their co-pay, co-insurance, and deductible up front, and uninsured patients are responsible for the full (estimated) cost of treatment.

Administrators at facilities currently using this practice argue that it is the most effective way to receive payment, particularly when so much of the burden is shifting to the patient. A great deal of costs for medical treatment become bad debt – in 2011 alone, hospitals provided $41 billion in care that was never paid for. Hospitals attribute this to patients’ reluctance to make their health spending a priority, and to a lack of awareness of financial assistance programs that can eliminate the strain of a single large payment.

The up-front model is an extension of one already in practice in most doctors’ offices around the country, where co-pays and co-insurance are collected at the check-in for an appointment. By implementing the practice in hospitals, administrators state that they can connect patients to financial assistance sooner and increase the likelihood of full payment.

Opponents of the idea, however, point out that up-front payments may create a barrier to receiving health care. As deductibles continue to rise, patients will be increasingly unable to cover the cost of their care and may elect not to seek treatment – in effect, creating a situation directly opposite the intended outcome of the Affordable Care Act.

PRN Funding offers healthcare factoring and medical receivables factoring services to vendors and facilities struggling to bridge the cash flow gap. Before shifting to the up-front model, contact us to see how we can help you meet your cash flow needs and continue to provide quality care to your patients.

Enhanced by Zemanta