Newly Insured Patients Present Revenue Opportunities and Challenges

May 28, 2014, 12:03 ET from UBM Medica US

NORWALK, Conn., May 28, 2014 /PRNewswire/ -- The Affordable Care Act has created "new" patients nationwide through the expansion of Medicaid and the creation of high-deductible plans sold through state and federal health insurance exchanges. While that means a potential influx of new patients for medical practices nationwide, it also presents some new challenges.

As part of the 2014 PayerView analysis, presented by cloud-based billing services and software company athenahealth, the effect of these new patients is one of several trends medical practices need to monitor in the coming months. Each year, PayerView ranks insurers on how well they work with healthcare providers based on millions of claims athenahealth processes for its medical clients nationwide. This data is run through an algorithm measuring payers' efficiency according to several metrics.

The latest analysis, appearing in part online and in the June 2014 issue of Physicians Practice, reveals that many practices may be faced with heavier collections burdens due to a surge of patients with high-deductible plans purchased through health insurance exchanges and the continued lackluster performance of Medicaid. For the ninth straight year, Medicaid performed worse than commercial plans and Medicare in key components of PayerView rankings, including days in accounts receivable and average denial rate.

This means that medical practices need to take several steps to survive this new influx of patients, including:

  • Communicate and work with patients on their financial responsibility;
  • Monitor payer mix; and
  • Manage billing and collections processes.

To help practices manage their payer mix, Physicians Practice presents PayerView rankings in these categories: overall top five payers; top major payers; top Blue Cross Blue Shield plans; top Medicare and Medicaid plans; and the top payers, broken out by four U.S. geographic regions (Northeast, Midwest, South, and West). The complete results are available through athenahealth.

"Medical practices nationwide are beginning to feel the effects of 'new' patients coming into their practice, presenting with more than just health issues," said Keith L. Martin, group editorial director for Physicians Practice. "These patients require a little more education on everything from copays and collection processes to basic medical practice orientation issues, so it is important that physicians and practice managers take steps to efficiently manage these visits and their bottom line. Knowing the performance of payers for Medicaid and high-deductible plans, as well as other payers in their region, is a highly valuable tool as practices examine their payer mix."

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Jason J. Golden
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