Announcement: Hillary Clinton made one this week she is running for president.

 

Confessions: These are an integral part of the Catholic faith.

 

 

Discovery Channel: A wonderful source for valuable educational programming.

 

Those are all synonyms for disclosure. 

 

In New York, physicians and hospitals are now required to follow several new disclosure laws in regards to providing care to patients who are out-of network. The changes took effect April 1 and apply to Commercial plans and some Medicaid plans, but not Medicare plans.

The intent of the law is to allow patients to easily determine which providers participate in their health plan network.  This  will give patients the ability to make an informed decision regarding utilizing an out-of network provider and the likely associated extra out of pocket expense that will be incurred.

Let’s see how this impacts the physician office and its workflow:

Participation information must be readily available on websites, in registration/admission documents and communicated directly to patients as indicated.

Notify patients which health plans they participate with and with which hospitals they are affiliated:

           Add this information to your practice website.

Update or create hand out materials to include these details that can be provided to patients.

Educate scheduling staff to inquire about a patient’s policy information when setting appointments and provide participation status.

*Perform a real-time eligibility check during or immediately after scheduling the appointment.  This is an easy way to confirm if the patient will be out-of network.

Iridium Suite Revenue Cycle Management software has a built-in real-time eligibility function with responses that can be used to “instantaneously” create a patient and their policy information.  Then the patient can be immediately put in the integrated scheduler.

 

Provide patient with an estimate of the bill for services:

If it is determined you are not participating in a patient’s health plan, staff should inform the patient prior to services being rendered and discuss the out-of pocket expenses.

*It is also prudent to discuss payment arrangements and set up the terms of a payment plan beforehand. This typically improves your collection rate and eliminates the after the fact uncomfortable conversations.

You can create customized super bill templates in Iridium Suite which will allow you to create an accurate estimate of the billed charges for the patient.

A payment plan amount and start date can also be entered in the patient’s account.

These arrangements are reflected on the patient’s monthly statement and can be easily tracked in the patient accounts receivables.

Notify patients of other providers who may be involved in their care, either in the office or hospital:

Update or create hand out materials to include names and contact information for those providers that can be provided to patients.

With health insurance exchange plans, high deductible plans, limited network plans, etc. it is crucial for both physician practices and patients to be well informed of the plan coverage and benefit details.  This information is the key to the financial success of your practice as well as fostering a good relationship with your patients and community.  This law may only be in New York, but the intent is valuable no matter where you practice.

 

Let us show you how our cloud based practice management software, Iridium Suite, can assist you in achieving your goals.