Oct 10, 2012 | Coding, Billing, and Collections, Laboratory News, Laboratory Pathology
This finding is reinforced by the fact that high-deductible health plans are now the second most popular plan option offered by the nation’s employers
Getting paid for expensive genetic cancer tests is likely to be tougher for clinical laboratories when the patient is covered by a high-deductible health plan. There are two trends that are contributing to this situation, each highlighted by recently-published studies.
One trend is the rapid growth of consumer-driven health plans (CDHPs). The second trend is growing evidence that patients, if they need to pay much money out of pocket, will decline to undergo genetic testing that is suggested by their physicians. (more…)
Apr 13, 2010 | Coding, Billing, and Collections, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Management & Operations
With more and more consumers participating in high-deductible health plans, health savings accounts, and other forms of consumer-directed health plans, physicians and laboratories have to collect substantially more money from their patients. Collecting from patients while they are still in the physician’s office is the ideal situation, but must patients don’t know what their copayment, deductible, or out-of-pocket is for any given service. In many cases, that means that the physician must bill the insurer, wait weeks for a settlement, and then bill the patient for the balance. Patients are somewhat unlikely to pay a bill for services rendered in the distant past.
To help with the problem of in-office collection, Companion Technologies has created a card reader that accepts patients’ credit, debit, or insurance cards called Companion Direct POC. These small machines feature a keypad, a screen, and a printer that prints a patient receipt. The process works in 4 quick steps:
1. Run healthcare card through Companion Direct POC healthcare card reader and enter patient-specific information
2. Patient information sent to appropriate payer
3. Plan information and eligibility sent back in seconds
4. Print receipt and eligibility information directly from card reader
The systems are inexpensive, running about $20 per month plus a 20-cent per transaction fee. For this nominal fee, doctors can insure that a patient knows what s/he owes before s/he leaves the office.
On January 9, 2007, Companion Technologies was purchased from BlueCross BlueShield of South Carolina and sold to The Thurston Group and ABRY Partners. Now that Companion Technologies has more financing than BlueCross BlueShield of South Carolina was able to provide this small part of its operations, Dark Daily predicts that Companion Technologies will expand its promotion and implementation of real-time eligibility verification systems across the country at a rapid pace.
Laboratories can expect to be effected in a number of ways by the spread of real-time eligibility verification and real-time claims settlement. First, patients will become accustomed to eligibility verification/claims settlement services from physicians offices and will expect to see them in laboratories, as well. This means laboratories must be prepared to deal with patients on a cash basis, accepting cash, credit cards, and health debit cards. Second, laboratories and pathology groups should enjoy a better collection ratio for patient-billed services because of the real-time billing. Aspiring laboratories will make proactive responses to this trend and see it as an opportunity to create a competitive advantage, keep existing clients, and grab more market share.
Related Articles:
Thurston Group and ABRY Partners Purchase Companion Technologies Corporation
Payers Begin Speeding Up Payment to Physicians The Dark Report, November 2005
Feb 12, 2007 | Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Kaiser Permanente has taken the radical step of introducing a new suite of consumer-driven products called Custom Care. This is the first time, since its founding more than 60 years ago, that Kaiser Permenante is offering a health insurance plan that is not based on its staff-model HMO. For lab directors and pathologists, this is an important sign of the steadily-increasing importance of consumer-directed health plans (CDHPs) in the American healthcare marketplace.
Kaiser Permanente first launched the Custom Care products in its California region in May 2006. According to the press release from Kaiser, “This new suite of Consumer Directed Health Care products offers a range of benefit design and financial accounts options, along with online health information, decision support tools, incentive and discount programs, and access to Kaiser Permanente’s integrated delivery system. Kaiser Permanente Custom Care provides customers with additional options to actively manage their health care expenses and provides consumers with the tools to become more active participants in managing their health care services and costs.”
Based on response to the response of its test marketing of Custom Care insurance products, an emboldened Kaiser upped their stake in CDHPs by launching Custom Care HealthInvestor HSA. These plans became effective on January 1, 2007. HealthInvestor combines a Wells-Fargo-administered health savings account with a high-deductible health plan in which members pay a larger share of bills in exchange for lower premiums. Kaiser does not expect people to flock to this new plan model, but says that it is laying the ground work for the future of health care. “It’s a new business strategy for us, “said Kaiser spokeswoman Beverly Hayon in the August 14, 2006 issue of Modern Healthcare, “to be much more responsive to the marketplace in terms of what our employers need and what individual consumers are looking for.”
Laboratories should take note that, when an organization the size of Kaiser Permanente feels obligated to offer consumer-driven health care options after 60 years of offering only HMO products, other large insurers cannot be far behind. Consumers enrolled in consumer-driven healthcare plans are more likely to be highly involved in their health care and to only want the bare minimum of health care services. They are also likely to shop around to find a fair and reasonable price for such services.
Laboratories and pathology groups need to track the progress of the CDHP trend. Consumers covered under high-deductible policies and HSA plans are being educated to shop carefully for healthcare providers and to use both price and quality to guide their decisions. To be competitive and to serve the changing expectations of patients, laboratories and pathology groups will need to create services that are patient-friendly and deliver this care in a cost-effective fashion.
