Did you know that a study in 2013 by the American Institute of CPAs found that more than half of Americans surveyed didn't know the meaning of at least one of three key health insurance terms (deductible, copay, premium)? And that more than a third thought that premiums were paid directly to doctors? Considering that health insurance is such an important part of personal finance, these results are rather shocking. But if you work in a medical practice, they're probably not surprising, especially if you happen to be a medical biller. If you're a biller, odds are that handling questions and misunderstandings about deductibles and other amounts billed to patients has come to occupy a significant chunk of your time. It doesn't seem like explaining health insurance terms should be your practice's responsibility. Shouldn't the vendor (i.e., the payers) take the lead in making sure the consumer knows how the product works? And what about employers who offer these products as benefits -- shouldn't they explain what their employees are receiving? In an ideal and logical world, practices wouldn't wind up having to explain how someone else's product works to their patients. But, unfortunately, the fact that patients don't understand how their financial responsibility is calculated (or even why they are being asked to pay) can have steep consequences for your practice. When patients don't understand what they owe, they're more likely to resist paying. The bottom line is that when patients don't understand their financial obligations, they are less likely to meet them. Even when patients do pay, collection costs rise when payment is delayed by misunderstandings. Even though educating patients about their payment obligations shouldn't be your practice's job, you must make it your practice's job if you want to be paid more reliably. Educating patients about their financial responsibilities should start before they arrive at your door. Working financial education into your practice workflow is more important than ever as deductibles keep rising. Learn more about the why and the how of clearing up misunderstandings about insurance in my webinar on 4/26. It's free -- hosted by
Did you happen to catch this New York Times Magazine article last month? It begins with a moving story of an uninsured patient who suffers a terrible brain hemorrhage. Thankfully, she gets timely, effective treatment -- but her condition requires many expensive services, including an air ambulance. Her bills totaled about $500,000. Although the patient had assets like a vacation home and savings, the amount she owed was greater. As the article describes the patient's profound stress in dealing with huge, unexpected bills while recovering, it seems clearly headed toward a case for single payer. However, it takes a rather astonishing twist along the way. The twist? The piece proclaims that little-known villains are secretly contributing to skyrocketing patient bills and healthcare costs: medical coders. "The guerrilla tactics of providers' coders," the article argues, involve deliberately manipulating physicians' codes -- i.e., diagnosis codes -- to create higher bills. If you are a practice manager, biller, coder, or independent physician reading this for the first time while sipping your coffee, perhaps you just spit it out in shock (like I did). Because while there may be billers and coders out there who have been urged to make up diagnoses to generate higher bills, I've never encountered one. I can only imagine "guerrilla coders" are exceedingly rare. The billers and coders we work with have enough to do just trying to get their physicians properly paid for the work that they've actually done (!). Physicians, billers, and coders have to work with the codes our entire industry uses to determine payment based on services rendered. If they aren't careful and don't check that all services are properly coded, practices (and hospitals) will receive less than payers have promised them for the work that they do. This is the problem billers and coders are trying to solve: Making sure their physicians and organizations aren't underpaid for services performed. That a trusted voice like the New York Times is promoting such a sinister impression of medical coding (among other inaccuracies in the piece) really bothered me. But something else bothered me more. Among the
Phreesia recently invited me to present a short (20 min) webinar on "The Patient of the Future," and how practice managers can anticipate emerging preferences to do a better job attracting and retaining patients. We have an interesting advantage in our field in that we have a bit of a lag before the trends of today become cost-of-doing-business requirements. (Except, perhaps, for pediatrics and other specialties that serve millennials -- you've got to try harder to stay ahead of the curve. Lots of interesting data shows why.) I think you'll enjoy listening to it (I'm biased, of course :)). It's a little headier than our typical tactical webinar -- nice to have a little variety. And it's available on-demand, for free. Here's the link to sign up and view/listen on demand. If you do check it out, I'd love to discuss it or hear your feedback. Visit this page to contact me or any of us at C&M via email or phone.