Are collection efforts by your staff abusive?
Definition of financially needy’ changing
Are uninsured patients billed at a higher rate than insured patients?
Did patient access staff fail to make reasonable efforts to determine if a patient is eligible for financial assistance?
Were patients billed for charges that would have been covered under the hospital’s financial assistance policy?
All of these practices are considered "abusive" under proposed new regulations from the Internal Revenue Service (IRS), warns Rachel Bienemann, senior director of Huron Healthcare, a Chicago-based consulting firm specializing in revenue cycle improvement.
"Collecting copays, deductibles, and out-of-pocket premiums for insured patients would not be considered abusive, under the new regulations," assuming the patient’s responsibility does not exceed insured rates and that the hospital provides notification of the financial assistance policy, adds Bienemann.
Many hospitals provide financial assistance not only to uninsured patients, but also to underinsured patients. "While the regulations do not spell out all of the inclusions and exclusions, it is widely believed that the standards are focused on patients considered in need of financial aid," Bienemann says.
However, with more patients obtaining high-deductible plans on the Health Insurance Exchange Marketplace, the definition of a "financially needy patient" is changing, says Bienemann. "It cannot simply be presumed as the uninsured population only."
The new requirements are "supportive of and similar to" the Emergency Medical Treatment and Labor Act (EMTALA), says Mark Rukavina, principal of Chestnut Hill, MA-based Community Health Advisors, but with emphasis that care will be provided for emergency conditions regardless of whether a patient is eligible for financial assistance.
The proposed rule states that "any hospital policy or procedure that discourages individuals from seeking emergency medical care, such as demanding that emergency department patients pay before receiving treatment or permitting debt collection activities in the emergency department, may jeopardize a hospital facility’s compliance with EMTALA and with the requirement under 501(r)(4)(B) to establish a nondiscriminatory emergency medical care policy."
The proposed rule clearly discourages any practices that would interfere with someone trying to access emergency care, says Rukavina. "Exactly what that looks like isn’t really clear," he adds. "You could point to an egregious example and say that it crosses the line. But these are delicate conversations."
Hospitals should be particularly careful when pursuing collections in the emergency department (ED) setting, cautions Rukavina. "There’s a lot of effort going into collections right now. Whether the patient is self-pay or underinsured, no doubt it’s best to collect at the time of service, because you eliminate any kind of collection cost," he says. "For non-emergent care, that’s within bounds and makes sense."
Hospitals should review their EMTALA policies and the new requirements, and "marry those two, especially for the ED setting," advises Rukavina. "Anything that could be seen as discouraging someone from seeking care is going to be frowned upon."
