The healthcare industry is abuzz with the latest update from the Congressional Budget Office (CBO) that, with the repeal of the individual mandate, premiums will increase approximately 15% next year and the number of uninsured Americans will rise by an additional 3M lives.
However, CBO is a “forecasting” entity and it remains to be seen what 2019 will actually look like, but healthcare providers need to prepare. That is why a forecast is important. Preparation is key to managing any potential crisis that may occur at a later date.
Recently I have noticed a dramatic increase in the rise of out-of-pocket (OOP) amounts owed by the patients we treat. While insured, there is a cost-shifting occurring from payers to patients on what they will allow of a provider charge, if non-contracted, or an increase in co-pays and deductibles.
More than ever before, it is vitally important that providers and suppliers of healthcare have a strategy on how to attack this issue. Here are a few ways to begin the management process regarding rising OOP:
1. Deductible management.
2. Understand the payer behaviors of the age groups of the patients you treat.
We identify age groups as follows:
- newborn to 18 years old
- 19 – 30
- Over 65
You will be surprised what your data tells you regarding how these demographics pay their outstanding balances. Couple that with a scoring product and you can really develop a strategic work plan for capturing monies from appropriate pay sources and demographics.
3. Use the 80/20 rule to identify your top payers and their payment behaviors.
As a manager and executive, you should understand how these payers are reimbursing you for emergency and non-emergency transportation. This ultimately impacts the bottom line.
There are solutions that can help you manage this process, as well. Solutions Group is a premier RCM solution to help combat the increasing self-pay phenomenon for providers of healthcare.