Browse by Topic
More than 40,000 members value HFMA's thought leadership and practical strategies. HFMA is where you need to be.
Get acquainted with the
healthcare finance industry's leading professional association. Find out why our
members rely on HFMA as their go-to source for insight and
Members have many
options for helping them advance their careers. Conferences, seminars,
eLearning, certification, and more -- our education and events will keep you
Connect the dots on today's big issues, explore collaborations, get career-boosting tips, and network with colleagues nationwide at the leading finance conference. Save $100 off the full conference rate when you register by May 8.
Real-time presentations with nationally recognized experts, networking opportunities, and industry solutions—no travel required!
Learn about timely healthcare finance topics and earn CPEs. Most live webinars are free for HFMA members and $99 for non-members. View the latest schedule.
If you're a subscriber to any of our three newsletters, you have access to online education. Learn more or subscribe.
Get the perspectives of leading healthcare finance professionals on today's hottest issues.
Information about leading vendors helps your buying decisions.
Forum members can network during live webinars or access a library of past webinars on topics such as bundled payment, charity care, and ICD-10.
An ever-expanding collection of spreadsheets, policies, job
descriptions, checklists, and more that you can adopt and adapt.
Forum members can submit vexing questions to a panel of experts
using our Ask the Expert service.
Your source for employment solutions.
Find new employment opportunities or
reach out to qualified candidates.
Distinguish yourself as a
leader among your peers and advance your career by earning certification in our
healthcare finance programs.
Get an objective third-party evaluation of products and services used in the healthcare finance workplace.
MAP App is a web-based application that helps organizations improve revenue cycle performance based on industry-standard metrics called MAP Keys.
Find suppliers and products in this comprehensive vendor directory for healthcare finance professionals.
Guidance for understanding and communicating about the price of health care.
Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
On April 17, the U.S. Department of Health & Human Services (HHS) announced that 8 million individuals have enrolled for coverage in the federal and state health insurance exchanges. It’s an open question as to how many of these individuals will pay premiums to finalize the enrollment process. Anecdotal reports from payers put the nonpayment rate at 10 to 20 percent of exchange enrollees. One thing that’s clear is, as expected, enrollees traded lower premium prices for higher out-of-pocket costs. Plans with higher cost sharing were the overwhelming favorites of exchange enrollees, with 63 percent selecting silver plans with another 18 percent choosing bronze products.
Bronze products have a 60 percent actuarial value, while the actuarial value for silver plans is 70 percent for individuals whose income is over 250 percent of FPL. By statue, the silver products offer sliding-scale subsidized cost sharing for individuals whose income is 250 percent of the federal poverty level (FPL) or less, which in part explains the popularity of these plans. For an individual at 250 percent of FPL (with an annual income of approximately $28,000) who purchases a silver plan, due to the subsidized cost sharing, the plan has a 73 percent actuarial value. As an example, for a standard silver plan in New York, the presence of the cost-sharing subsidy drops the out-of-pocket maximum from $5,500 to $4,000 and the deductible from $2,000 to $1,750.
Although the reduction helps, the cost-sharing subsidies are probably not enough to help individuals resolve many of their outstanding balances. Not surprisingly, an analysis of historical balance after insurance data show that across all percentages of the FPL, as an outstanding balance after insurance increases, the yield decreases significantly. For individuals between 200 to 400 percent of the FPL, approximately 50 percent of balances less than $250 are collected. When the balance increases to more than $500, the yield drops to 16 percent, according to a data study by Waltham-Mass.-based Connance that HFMA submitted to the IRS to contribute to the agency’s 501(r) rulemaking process.
A similar trend holds for the relatively affluent (> 400 percent of FPL). Smaller balances after insurance (<$250) yield almost 60 percent. However, the yield drops to 25 percent when the balance is greater than $500.
As the trend to higher cost sharing continues in both health insurance exchanges and employer-sponsored segments, the findings above suggest that providers will need to refocus their efforts on efficiently resolving self-pay accounts to maintain and improve margins. Key to achieving efficient account resolution is the ability to effectively communicate with patients about their financial obligation either prior to or immediately after the time of service. The goal of this communication is help patients understand how the billing process works and either provide them (if uninsured) with a specific estimate of their out--of-pocket responsibility or (if insured) direct them to the appropriate resource to obtain this information.
The findings also have implications for providers’ charity care and prompt-pay discount policies. Patients apparently find relatively small increases in balance daunting, as is evidenced by dramatic decreased in collection yields. Although providers will need to study their self-pay experience, offering a greater percentage discount on higher balances (either charity care or prompt-pay, or some combination of both) tailored to sliding scale FPL could increase self-pay yield significantly.
Chad Mulvany is director, healthcare finance policy, strategy and development, in HFMA’s Washington, D.C., office.
Publication Date: Thursday, April 24, 2014
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Dale Hockel, senior vice president of operations, and Jim Fanelli, CFO, TriMedx, share strategies for elevating clinical engineering through innovative management programs.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
Scott Schmidt, vice president, Cerner RevWorks, LLC, shares insights on best practices for maximizing a revenue cycle management partnership.
©2015 Copyright Healthcare Financial Management Association
HFMA.org is best viewed using IE9 or the latest versions of Chrome, Firefox, and Safari.
Join HFMA today and enjoy: