The ACA in the Southeast: Adapting to the New Landscape
March 3, 2017
The southeast has largely reacted to the ACA differently than much of the country.
While the Affordable Care Act dramatically altered the healthcare landscape across the entire U.S., its impact has varied significantly between regions. Case in point: the Southeast.
With exchanges leaving, rates fluctuating and tax credits unused, hospitals in this region must meet goals, cut costs and streamline claims processes without overcomplicating things or losing time. To better adapt to this new but fast-changing environment, hospitals need to keep their work cycles manageable. Otherwise, the ACA’s particularly chaotic effect on the Southeast will lead to tremendous efficiency complications. Let’s take a closer look at four of the different ACA-related factors that could disrupt standard hospital performance in the Southeast.
Medicaid (un)expanded
While the ACA attempted to broaden the reach of Medicaid, the Supreme Court’ s decision in National Federation of Independent Business v. Sebelius ruled the federal government could not mandate that states accept this expansion – and states in the Southeast have proven particularly unwilling to embrace the extension voluntarily. In total, 31 states
have expanded coverage under the ACA.
According to the Kaiser Family Foundation, most of the southern states, including the Carolinas, Florida, Georgia and Mississippi, opted out of these expansions. As of October 2016, the list also included further west states, such as Texas, Oklahoma and Missouri.
“To keep their work cycle manageable, hospitals should pay specific attention to workers compensation
and auto accident
medical billing processing.”
Insurers leaving the market
Buyers in the Southeast face the possibility of fewer—or at least different—choices for their areas given changes to the law and business coverage.
The Associated Press reported residents in Virginia may find themselves with only a single insurer. As many as 7 million people were thought to be either outside healthcare markets or ineligible for specific income-based assistance. Premiums are also set to go up by a full quarter on average in several southern states, and such a significant increase will inevitably cause major disruption throughout the healthcare sector.
New expectations in 2017
It’s impossible to avoid the way recent political events have also brought the future of the ACA and general healthcare coverage into question. President-elect Donald Trump and his surrogates have
openly criticized the Act and promised to repeal it.
However, Trump has also admitted to favoring certain aspects of the care model, and some have questioned how long it would take for Trump to accomplish his goal. Depending on whether his administration changes the act, states which currently opposed elements of the law could find themselves changing their minds if it takes a different form. In any event, Trump’s win has certainly put a question mark over the actual future of the law and whether it will be completely replaced. Given the current level of chaos surrounding the ACA in the Southeast, these unknowns pose even greater challenges for hospitals in this region than those in the rest of the country.
Finally, there’s the growth of different covered residents to contend with. Reuters recently reported on the more than 1 million members
set to receive health insurance through exchanges in the coming year. While this is lower than anticipated, the government still expects 11.4 million people to sign up each month next year.
In those states where confusion reigns regarding the ACA—i.e. the Southeast—many people on these exchanges may not fully understand their coverage. MPB Online reported 22,000 insured Mississippi residents may be missing out
on tax credit benefits for which they qualified, for example. This lack of clarity further complicates the claims process not just for patients, but for hospitals and insurers as well.
Simplifying when possible
Considering all of this, hospitals in the Southeast should look to streamline and cut down the costs of their operations wherever possible. One of the best options: outsourcing workers compensation and automotive insurance revenue cycle management to a dedicated partner. While these two areas represent a small portion of hospitals’ total revenue cycle, their level of complexity requires a disproportionate degree of expertise. Working with a partner like PROMEDICAL simplifies matters, minimizes the risk of missteps and maximizes claim success.
In 2016, healthcare vendors need the most efficient claims processing systems out there. By now, flexible, web-focused methods for important claims tasks are clearly the industry's path forward, and will play a major role in bridging the gap between patients and providers. A fast, digital claims method makes a direct link from implementation to delivery for workers' compensation and motor vehicle billing alike. Now is the time to invest in better revenue cycle management, with a focus on detail-driven, well-facilitated collection that breaks down barriers. Despite the growing pains involved with adopting any new technology, there are a couple of areas where smarter systems have already improved claims processing online. Direct accessibility With each new convenience, the future of healthcare looks more integrated. Data analytics harvests insights from seemingly unrelated details for fuller results. To make this innovation worthwhile, however, there needs to be a distinct pipeline between entities. "Data analytics harvests insight from seemingly unrelated details." Online healthcare portals are already addressing this need, providing direct communication through smart devices like phones and tablets. By bringing necessary information together in a simple, accessible source, these solutions set the stage for clean claims assembly. Shorter cycles Proper collection from the outset can reduce the amount of work hospitals have to do later if the claim is resubmitted, according to Gary Marlow, Vice President of Finance at Beverly Hospital and Addison Gilbert Hospital. "From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration," Marlow told RevCycleIntelligence in 2015. "That provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible." The way information enters the claims process can impact how it gets managed. If technology, like artificial intelligence, is present at the beginning and guides the claims throughout, there's a consistent system handling the information the process to meet best practices. PROMEDICAL's benefits With our secure, efficient and comprehensive system, PROMEDICAL is staying ahead of the game. We're doing that by developing the following features: Communication: Users can choose from multiple languages with our online offerings. This allows you to customize your system to better reach patient populations and keep claims moving faster. Customization: If our proprietary options aren't currently meeting your needs, we can change them to do so based on feedback. Adapt to state fee schedules or language demands on a case by case basis. Encryption: A must for secure file exchange, PROMEDICAL ensures a secure file transfer process. Our process protects backup data equally strong as primary data, for efficient security across the board. Planning: Organizations also benefit when a set deadline is involved, putting clear limits on when submissions are set for review. Processing records requests within a preordained period of days helps managers know what to expect, and regular reports set up clear overviews of important statistics. Contact PROMEDICAL today to learn more about our healthcare revenue cycle solutions.
According to Pew Research, 15 percent of U.S. adults have used ridesharing services . Where does insurance enter the picture? Uber, Lyft and other ridesharing apps throw a proverbial wrench in hospitals' revenue cycle management operations. Billing is already a major pain point in hospitals – Black Book Research noted most facilities are outsourcing their RCM because in-house teams lack the resources to efficiently handle motor vehicle reimbursement. Ridesharing will only exacerbate the issue. For example, if a rider gets injured and has to go to the hospital, from which institution does the hospital receive reimbursement : The driver's insurance? The passenger's? Uber's? As Uber and Lyft are the most popular ridesharing apps, we'll focus on how these companies handle driver insurance. How do Lyft and Uber insure drivers? Lyft has three types of coverage within its insurance policies: Contingent Liability activates when a driver logs into the app and requests to accept rides – a state Lyft designates as "Driver mode." This coverage provides up to $100,000 per accident for bodily injury. Contingent Comprehensive and Collision kicks in when a driver has picked up a passenger. This coverage applies when a non-collision event damages the driver's vehicle. Uninsured/Underinsured Motorist applies when an at-fault driver who is uninsured or underinsured causes bodily injury to himself, his passengers or any third parties. The coverage provides $1 million per incident, and includes no deductible. For example, if a driver is injured in an accident at a time when he is not working for Lyft, his personal insurance will cover him (assuming he lives in a no-fault state, but that's another issue). However, when the driver activates Driver mode, Lyft's Contingent Liability will protect him even if he hasn't accepted a ride from a passenger. What if the driver's at fault? According to Rideshare Dashboard, Lyft's commercial insurance will cover all damages to third parties and the passenger, but the driver will have to cover his own medical expenses. That's when state laws dictate payment. In Massachusetts, for example, which also happens to be a no-fault state and requires all motor vehicle owners to possess auto insurance, the rider's personal auto insurance will cover the medical bills. Uber's insurance system is somewhat similar to Lyft's but possesses a few minor differences. For example, when an Uber driver is transporting a passenger, and another motorist causes an accident that results in bodily injury to the driver, the passenger and anyone else involved, Uber's UM/UMI will cover bodily injury of anyone in the rideshare vehicle.
With new, transformative technological advancements on the rise, it's no surprise that nearly every industry is feeling the impact of the digital age. From a healthcare provider's perspective, new resources can be used to revamp the current revenue cycle management processes you have in place. To reap the benefits of an optimized approach, you must be willing to take advantage of such emerging technological tools and resources, as stated by Chad Sandefur, Director and Healthcare Analyst at AArete. "Generally speaking, in order to strengthen the revenue cycle management, embracing technology within the revenue cycle is key," Sandefur shared with RevCycleIntelligence.com. "Having the platforms to seamlessly facilitate provider-payer interactions are really integral. In many cases, it's mostly about bad debt avoidance. With that in mind, there are a few specific points." Let's take a closer look at the benefits of utilizing technology, plus some of the emerging resources your facility can use to revamp your current RCM processes: The benefits of an optimized approach By paying attention to the new digital advancements that can benefit your RCM, you can ultimately impact the workflow of your staff members while better streamlining services for consumers. Here are some of the advantages of an optimized approach: Reduced chance for human error – Human error is inevitable when handling large amounts of data. Management software can be used to keep track of patient data input and maintenance. Better opportunity for precise, automated data entry – Between appointment scheduling, data input and claims submission, employees have a lot of duties. Automated software can take care of some of these responsibilities, allowing staff members to better focus on a single task at a time. I ncreased cash flow – Claims management technology can expedite claims quickly and produce clean, accurate claims, ultimately increasing cash flow , as stated by Becker's Hospital Review. Optimizing your RCM approach can lead directly to a significant return on investment and improve the overall reputation of your billing department.
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