Throughout the country, financial regulators have gathered in the healthcare payments space to battle a powerful and persistent enemy: the nation’s medical debt.
Amid significant state and federal regulatory changes, the revenue cycle management (RCM) regulatory landscape reflects a greater emphasis on patient protection, financial assistance, and charity care programs. But for revenue leaders staying compliant means not just staying informed but how these changes will impact what can and can’t be done with respect to patient billing.
In our recent webinar, KaLynn Gates, Chief Commercial Officer and General Counsel at AccessOne, provides revenue leaders a run-down on the newest regulations shaping the revenue cycle—in particular, how certain key happenings in Florida, Maryland, and North Carolina could potentially transform the entire regulatory ecosystem.
Navigating the Current RCM Regulatory Environment
Medical debt is a persistent problem and key factor shaping policy changes at the state and federal levels. By understanding what, where, why, and how new regulations are taking place, revenue leaders gain the necessary tools to navigate a shifting financing environment and do right by patients in a complex system.
Let’s dive into the key issues and policy themes every change-ready revenue leader should know.
- Charity Care
- Call for greater transparency from Providers regarding charity care programs and Universal Screening for Financial Assistance and presumptive eligibility for free care
- Affordability
- Required availability of income-based payment plans
- Bad Debt Collection Practices
- Restrictions limiting the reporting of medical debt to credit agencies and protections for defendants facing debt-related litigation
- Legal Protection for Patients
- Expanded price publication and transparency requirements
- Preemptive disclosures for patients placing medical debt on credit cards
- Structured processes for challenging incorrect bills
- Debt Relief Programs
- Non-profit organizations and third parties using public funds and grant money to purchase and forgive medical debt.
Need-to-Know Changes on the State Level
For a growing number of state policymakers, affordability is key. Let’s zoom in on some notable examples that could impact revenue leaders throughout the country.
Florida
In Florida, the recently passed House Bill 7089 on Healthcare Expenses requires price transparency from hospitals and providers. Among other requirements, organizations must publish standard charges for common services and provide patients and insurers with price estimates, mirroring federal surprise billing rules.
North Carolina
Following newly enacted policies tied to Medicaid expansion and the state’s entry into the federally funded Healthcare Access and Stabilization Program (HASP), North Carolina’s hospitals need a cost-effective method for notifying patients about payment plans, obtaining data like household income at scale, and determining how charges outside the HASP are handled.
Maryland
Following the Health Services Cost Review Commission’s guidelines, hospitals need to notify patients about the availability of income-based payment plans and allow for modifications in the event those individuals can no longer afford their charges.
Tracking Federal Developments
On the national stage, the Consumer Financial Protection Bureau (CFPB) has taken a front-seat role in healthcare financing, collaborating with the Department of Health and Human Services (DHHS) and the Department of Treasury to strengthen debt collection.
The Internal Revenue Service (IRS) recently announced its plan to audit tax-exempt healthcare entities, and the DHHS has continued its effort to reduce the burden of medical debt on households. By and large, these government agencies are slowly but surely designing policies and practices to build transparency, mitigate citizens’ financial burdens, and support the system’s fiscal health.
Preparing for the Future
Although many of these changes are taking place on the state level, their impact will likely span entire regions. RCM teams must understand the ‘why’ behind these latest requirements and leverage those insights to create ethical and legally compliant programs.
Just as well, leaning on experienced vendor partners and industry trade groups can ensure alignment with regulatory requirements and help support a patient-centric financing product. As a leading partner for healthcare providers, AccessOne has the tools and expertise to help revenue leaders navigate the uncertainty and optimize the patient financing experience.
To learn more about specific regulations impacting your RCM environment, watch the full webinar.
