COVID-19 CHANGES PAYER MIXES FOR HEALTH CARE

As COVID-19 has rocked the economy and everyday life as we know it, millions of Americans have experienced job loss causing them to move from employer-sponsored, commercial health coverage plans to Affordable Care Act markets, state Medicaid programs or become uninsured. These changes can be a major factor in patients searching for a new physician during a pandemic, but industry leaders have been reporting a drop in new patient volume from the first half of the year. Early estimates show that more than 10 million will lose employer-sponsored health insurance as a result of pandemic job losses between April and December 2020.

What you can do
Health care leaders should take extra care in confirming insurance and eligibility for their patients before their visit. It is also a good time to review policies on upfront copay or coinsurance collections, payment plans, self-pay discounts and charity care as applicable.

Patients most impacted by the pandemic may request more flexibility with payment, especially those under a high-deductible plan. Transparency with patients before, during and after their visits on any balances owed by the patient will improve your practice collections and patient experience. Substantial changes in payer mix will shift a practice’s collection ratio and may result in a loss of revenue. Practices with a significant change from commercial insurance and Medicare to Medicaid will generally experience an overall decrease in revenue.

• Administrators should be regularly tracking key performance indicators (KPI) including payer mix more than usual, allowing the practice to trend the changes and determine financial ramifications for future payments.
• May be necessary to evaluate and renegotiate rates on commercial contracts in the event of a drop in net revenue from your payer mix
• Office hours may need to be adjusted to see more patients per day to achieve the same level of revenue based on your new payer mix
• Using benchmarking data, KPIs, evaluating payer contracts, increasing access and maximizing A/R collections are more important during periods with a decrease in patient traffic

Contact UHY healthcare professionals to further discuss.