Health Insurance

Medicare Advantage Plans Are Lucrative for Insurance Companies

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In an effort to control Medicare costs, the government few years ago introduced Medicare Advantage plans which are administered by private insurance companies.

Medicare pays the insurance company a fixed amount per enrollee per year to manage the care provided to the beneficiary who enrolled with the insurance company.

These beneficiaries opt out of the traditional Medicare plan administered by the Government. However, they may re-enroll with traditional Medicare during open enrollment.

These plans are aggressively marketed by insurance companies to Medicare beneficiaries. They have proven to be “cash cows” for the insurance industry.

The insurance companies reimburse as per the Medicare rates, however to make them attractive to the average Medicare beneficiary they add extra benefits including health club memberships in some cases.

On the surface the reimbursement per enrollee seems reasonable. However, the government has complex formulas, where for patients with many illnesses the insurance is reimbursed several thousand dollars more to manage these situations.

The New York Times recently had an interesting article where a national insurance company was fined several million dollars by the government for manipulating the diagnosis on such claims to qualify for the extra dollars.

What is the impact for you the physician?

Unlike, traditional Medicare which does not require prior authorization, Medicare Advantage plans operate like any managed care plan. This puts an extra burden on the practice to ensure all the rules imposed by such insurance company are followed prior to rendering care.

The denial rate on claims for these Medicare Advantage plans is much higher than traditional Medicare. This increases the cost to collect from these plans.

As a practice you must be familiar to recognize this pool of patients and follow all the rules and regulations prior to rendering the service.

Cutting Benefits to Medicare Recipients – Boosting Insurance Company’s Profits:

From the initial introduction of these plans, the insurance industry has found how to make these plans very profitable. Since the government has given them flexibility in offering benefits and managing care insurance companies have benefited tremendously from offering these plans. The government has also benefited to some extent in controlling their costs and continue to encourage beneficiaries to opt for these Medicare Advantage plans.

It is evident from the movement in the stock prices of all the large healthcare companies that Obamacare had been a bonanza for the profitability of such companies. All the companies stock prices have increased by over 300% in the past five years. This is all despite many experts saying that the Obamacare laws would be “bad” for the healthcare companies and their stock values.

Who are the losers?

The patient and physician are both disadvantaged with these plans. The patient must make sure that they follow the guidelines for care to ensure the provider is paid for the service and they are not held responsible. The physician has the added cost for billing and getting all the prior authorizations before rendering care or less they will not get reimbursed for the services.

It is a sad commentary, the two most important entities in the healthcare equation: Patient and Physician continue to be victims in the US healthcare system.

If you are seeking advice on how to reduce your losses to Medicare Advantage plans or looking for insight on how to navigate healthcare plans please feel free to contact us. 

Topics: Healthcare ConsultingHealthcare PaymentsHealthcare InsuranceMedicare,Medicare AdvantageInsurance CompaniesObamacare


Medical Billing

6 Strategies to Make Getting Paid Easier as a Healthcare Professional

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As a doctor, you know full well that many of your patients struggle to pay their bills on time. You’ve taken several steps to increase collection of payments due across your practice, but unfortunately, sometimes, it feels as though you’re getting nowhere! You need to keep the lights on in your practice, pay your staff, and ensure that your own paycheck is taken care of, so how do you convince your patients to pay their bills? These six key strategies will make it easier to collect on medical bills.     

1. Let Patients Know What It’s Going to Cost

Medical bills aren’t always expected, but many procedures can be prepared for ahead of time. In many cases, preparing patients for the cost of those bills will allow them to budget or even to put off a procedure that might not be necessary until they’re able to cover the cost. Be honest: check with the patient’s insurance, see whether or not they’ve met their deductible for the year yet, and make sure you’re including all the costs that go along with the procedure.

2. Collect Upfront

Before you see your patients, go ahead and collect copays, deductibles, and other key amounts for them. Train your front desk staff to insist on this payment before patients are able to come back into the office. If they offer an excuse instead of a form of payment, train your staff that, unless it’s an emergency appointment, their appointment should be rescheduled.

3. Create Options for Payment

Allowing patients to use a payment schedule to pay off medical debt is a great way to keep bringing those payments into your practice even when your patients are struggling to come up with the extra money. By offering solid payment schedules, especially if you offer emergency services or services that are needed quickly, you help create a better rapport with your patients and let them know that you’re willing to work with them. Offering payment plans when you contact them is also a great way to get patients to start paying on an old debt.

  1. Mention Debt When You Connect

Do you have patients who are in your office on a regular basis–and who are steadily incurring more medical debt? What about patients who are due for their next annual appointment, but still haven’t paid for last year’s? When you connect with your patients through appointment reminders, annual visit reminders, and other means, make sure that you mention the unpaid bills. In some cases, your patients may have simply forgotten about them completely!

  1. Use a New Method of Connection

If you urgently need to get in touch with a patient, how do you do it? While bill collection might not be urgent, it is necessary–and simply sending a letter every 30 days may not be the incentive patients need. Instead, when accounts reach a certain number of days past due, go ahead and connect with patients over the phone or by email. This is especially helpful if you offer them the ability to make a payment, pay the bill in full, or even set up regular withdrawals from their account right from where they are, rather than forcing them to remember to do something later.

  1. Use Effective Revenue Cycle Management

You need to concentrate on seeing your patients, and your office staff has plenty of other things to occupy their time. By working with a revenue management company, you can increase the odds that patients will take care of their bills on time without substantially increasing the efforts of your staff.

There are times when you’ll feel as though getting patients to pay their bills is the most difficult part of your job. Fortunately, we’re here to help. If you need help getting your patients to pay their bills on time, contact us today to learn how we can partner with your practice to ensure more effective revenue management.

Topics: Healthcare ConsultingMedical BillingAccounts Recievable Management,ClaimsHealthcare Payments