Four imperatives for navigating health insurance exchanges


The Affordable Care Act set up
health insurance exchanges, and they’re expected to add as many as
24 million new patients by the year 2016. That many new patients are going to
come with some significant growing pains. But there are four things that you can
focus on in order to meet these challenges. First, you need to realize that these new
patients are also new revenue opportunities. Exchange-based plans mandate
coverage for a wide variety of services, and you’ll know exactly what’s covered. This can boost your volume for a lot
of services, particularly primary care. More importantly, you’ll be turning uninsured
patients, or pure self-pay patients, into revenue-producing patients. Second, you’ll need to actively enroll
as many patients as possible in order for them to become revenue opportunities. Remember, they’re only revenue
opportunities after they’re enrolled. And some young, healthy patients might
decide not to pay for insurance each month, because penalties will likely be
cheaper than the premiums. In that case, you need to make an effort
to educate them on the value of insurance in order to maximize enrollment. You’ll also want to decide whether or
not you want to become a navigator. Third, you must make patients aware of their
obligations, and make it easy for them to pay. Remember, exchange plans have high deductibles, so it’s important for you to capture
these out-of-pocket costs. Cost-sharing subsidies also means more complex
billing, as well as more complex collections. It’ll be essential that you identify these
obligations at the point of service. Finally, be prepared for payer mix changes. There is the possibility of reduced commercial
volume, depending on your local market. If your state hasn’t expanded Medicaid, you may find that many low-income patients will
remain ineligible for Medicaid or exchange subsidies. Either way, conduct a market analysis right away. Over the next few years, exchanges
are going to insure millions of patients. Sure, that’ll mean some challenges
for your revenue cycle. But with the right insight, you can
thrive under these changes.

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