Since the implementation of the Patient Protection and Affordable Care Act in 2010, the IRS has been crafting a set of regulations specific to charitable hospital organizations and how they must update policies and procedures in order to be compliant under the act.
Healthcare providers are faced with ever-changing industry standards, regulations and restrictions. The presenters at this year’s New Jersey HFMA Annual Institute shed some light on three issues plaguing the industry under the current reforms, and offered various solutions to help providers not only to succeed, but to thrive in today’s environment.
If you talk to any hospital revenue cycle executive, they will tell you the extreme importance of having a strong relationship with an ethical and compliant collection vendor. After all, it is the money collected that keeps the hospital in business. However, medical collections have always been a little bit different than other debt collections. Most people do not plan to go to the hospital, they find themselves there unexpectedly. After the illness or injury that landed them there, they enter an extremely confusing world of EOBs, deductibles, co-pays, per diems, capitated rates, and many other terms they do not understand. It has always been important for hospitals to choose vendors who understand these dynamics. However, in the face of non-profit healthcare collection reform under 501(r), it is even more important for hospitals to make sure their collection vendors are set up to comply with the new regulations.
Last week’s HFMA Maryland chapter event, The HealthCare “Three R’s”: Regulation – Reform – Reimbursement conference, shed light on the effects of the Affordable Care Act in Maryland, and how the local healthcare community is reacting to the reform.
Nonprofit hospitals in particular are feeling the strain of new regulations on top of increasing patient balances and stricter collection requirements. Deductibles are up nearly 40% from the average for an individually purchased plan before the health care reform, yet the Affordable Care Act requires nonprofit hospitals to follow “reasonable billing and collection requirements,” and to cease “extraordinary” debt collection. But what is considered “reasonable” or “extraordinary”?