Patient Financial Responsibility

Patient financial responsibility is one of the critical factors that transform Medical Billing services. However, the Public Health Emergency (PHE) has new insights on patient-centric healthcare revenue cycle management services.

The COVID-19 era has brought a paradigm shift in healthcare consumer behaviors as patients spend more time at home and are increasingly going digital. Healthcare consumers are adopting digital technologies to create cost estimation, predict payments and other billing and insurance related calculations that help them stay on top of their financial responsibilities.

Before the pandemic scenario, some of the primary concerns of healthcare consumers included Price Transparency, maximizing insurance plans, and other patient-centric revenue cycle components. But, the COVID-19 outbreak has altered the healthcare financial landscape forever. Calls related to medical billing guidance and financial plans have surged at about a whopping 30 to 40% in the wake of COVID-19.

Calls related to medical billing guidance and financial plans have surged at about 30 to 40% in the wake of COVID-19

The growing spikes in healthcare expenses and the steadily increasing patient financial responsibilities are some of the topmost concerns in the COVID-19 scenario. The initial phases of the pandemic had several turbulences around billing and patient responsibilities. To mitigate the impact, the Centers for Medicare & Medicaid Services (CMS) made several announcements on regulatory flexibilities and policy changes that supported the digital healthcare and Remote Patient Monitoring solutions. However, research indicates that the COVID-19 situation has led to insanely high out-of-pocket expenses ranging at about $1300 for patients with employer-sponsored coverage.

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The sudden surge in out-of-pocket costs has raised concerns among healthcare systems around patients deterring COVID-19 related treatments. This poses a serious threat to the community, considering the huge spikes in COVID-19 cases that are extremely contagious.

The healthcare ecosystem is focusing on patient financial responsibility to address these concerns. Some of the contingency plans include new patient cost-sharing models, suspending patient billing among other initiatives.

Involve Patients in the Financial Process in the Initial Stages

Patient engagement solutions are key to enhancing patient experiences and driving success in population health management. However, providers need to take steps to provide hyper-personalized and high-touch consumer experiences. Engaging patients through Revenue Cycle Management Services has most often been overlooked by healthcare organizations. Hospitals and Practices have developed new strategies and implemented next-gen technologies to streamline copayments and collections. However, they need to increasingly focus on broadening insurance opportunities, and providing better billing support.

Suspending Patient Billing

This is one of the key measures taken by health systems to enable better access to care. When patients want to take a COVID-19 test or treatment, the cost of care should ideally be the last thing they need to worry about. That’s exactly why health systems have innovated new strategies to reduce or eliminate patient billing in the face of the pandemic.

This decision was made so the high out-of-pocket expenses do not stop the patients from seeking treatment or taking up a test when they experience the symptoms of coronavirus. It is of utmost importance that COVID-19 symptomatic patients approach a doctor and take necessary steps immediately without any delays that may be caused due to financial responsibilities.

However, the American Hospital Association (AHA) has also taken risk mitigation efforts to help hospitals and Practices cover the cost of care—as healthcare organizations cannot afford to suspend all the fees.

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Eliminating Patient Out-of-Pocket Costs

Medicare and leading other private payer organizations are taking a similar approach to reduce patient billing for COVID-19 treatment and testing. CMS has made several announcements on the COVID-19 interim final rule to maximize payment flexibilities for COVID-19 vaccines, testing and treatment. As per the fourth COVID-19 interim final rule, Medicare will cover the vaccine costs for Fee For Service (FFS) and Medicare beneficiaries. The Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund ensures that vaccine costs are covered for uninsured patients.

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