Friday, May 26, 2017

Budget Proposal for 2018 May Cut Support for Disability Social Security

The White House is in the final stages of readying the 2018 fiscal budget that seeks to resolve the economic deficits the government is currently facing. Central to its plan of achieving this goal is making drastic cuts to mean-titled entitlement programs, such as Temporary Assistance for Needy Families, Supplemental Security Income, child nutrition programs, the Pell Grant program and food stamps.

This development comes as a surprise, especially after President Trump had made it a focal point of his campaign that he will not be cutting into these programs. While reports indicate that the budget changes will primarily be focusing on means-tested programs, there is also word that the Social Security Disability Insurance program will also be affected by these changes.

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Thursday, May 25, 2017

Eligibility for Medicaid May Be Changed by the Proposed Replacement for Obamacare

Medicaid has played a big role in keeping millions of Americans adequately insured and protected with a viable health coverage. Specifically designed to make healthcare more accessible to low-income Americans, Medicaid implements a strict standard before an individual can be declared eligible for the benefits offered.

Many of the beneficiaries of Medicaid are elderly or disabled. The program’s existence is crucial to states delivering quality healthcare to their constituents. States and local governments must carefully balance their budgets to have adequate resources to allocate for this program.

Uncertain Future

Medicaid as well as the rest of the components of the Affordable Care Act (Obamacare) remains under threat of repeal and replacement. It had a very close call only recently, but the reprieve is short as another proposal has now been passed by the GOP.

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Wednesday, May 24, 2017

Challenges in Healthcare Revenue Cycle Management and How Hospitals Can Weather the Storm

Last year, local hospitals reported good records despite the challenges in revenue cycle management. Increasing operating costs, regulatory issues, flat reimbursements and the switch from patient volumes to lower-paying outpatient and observation services didn’t faze many healthcare providers. Thanks to a strong stock market and lower tax-exempt bond costs, hospitals continued to do well.

While this is good news, providers can’t be complacent now with the changes and regulations awaiting the Affordable Care Act. Under the Trump administration, the U.S. House Republicans recently gave the greenlight to a bill that would revise the 2009 Obamacare. It still needs to get the approval of the Senate, but many are concerned about the impact it will have if it’s passed.

Repealing the Expansion of Medicaid

One of the major concerns is Medicaid expansion. If the bill pushes through and removes that program, it will affect people who are enrolled in it, along with the revenue of their associated hospital. St. John Providence Health System in Warren, for example, has seven hospitals and 670,000 people enrolled in Medicaid. Non-profit hospitals like these will be the hardest hit when Medicaid expansion is repealed.

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Tuesday, May 23, 2017

The Digital Environment Revenue Cycle Management Companies Are Building

Major changes in revenue cycle management (RCM) technology are in store for health providers, including the small physician practice market. Currently, small medical practices are having a hard time handling the fast growth of patient payments, account management inefficiencies, and regulatory environment changes. These difficulties affect their collection of revenues, which can eventually derail the quality of services patients get when left ignored.

However, the use of electronic health records (EHR) is starting to change the landscape and improve the way healthcare organizations gather, analyze and report data. Experts believe that advanced RCM systems will keep on expanding as RCM providers work to incorporate new tools with unified platforms to enhance patient engagement, population health management and analytics. In fact, 97% of hospitals and nearly three quarters of providers are utilizing certified EHR technology.

EHR implementation poses challenges, as well, since the shift from paper to electronic records would demand a lot of time, energy and capital of a healthcare organization. These changes also call for additional training for staff involved in RCM and familiarize themselves with the ins and outs of the technology.

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Monday, May 22, 2017

With Social Security in Trouble, One’s Eligibility for Social Security Disability May Become Unclear

There has been a number of discussions in Washington about the future of social security in the country. Some argue that it needs major reform. To compound matters, the sum of the President’s actions in recent months seem to imply that disability benefits and social security itself may soon be in danger.

Cost of Social Security Continues to Rise

The Social Security Disability Insurance program has continued to grow in costs over the past few years. In fact, reports estimate that it cost $143 billion back in 2015. As the costs continue to rise, officials are now saying that the disability part of the Social Security Trust Fund may well be completely exhausted by year 2022. Should this happen, benefits would automatically be cut for everyone.

In the past, lawmakers acted urgently to stabilize the disability fund. In fact, in 2015, they transferred funds from Social Security’s main trust fund to help fund disability. This time around, however, this kind of ‘fix’ may no longer work. That’s because the scenario has become more complicated than in previous years.

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Friday, May 19, 2017

Social Security Disability Eligibility Faces Investigation Due to A Slew of Fraud Cases

Recently, the Social Security Administration has reportedly taken some steps to both identify and assess various fraud risks when it comes to its disability programs. According to the U.S. Government Accountability Office (GAO), the administration had managed to gather information on fraud risks during the past year, but the method had not been systematic. Moreover, the significance, likelihood and impact of all the risks identified was also not assessed. With this, hospitals and healthcare providers need to anticipate possible changes in eligibility requirements.

Fraud in Disability Has Been Going On for Some Time

During the fiscal year 2015, the payments from both Social Security Income and Disability Insurance programs amounted to approximately $200 billion. Currently, the extent of fraud across both programs are unknown.

However, several high-profile cases have made it clear that a number of individuals have managed to obtain millions of dollars in benefits fraudulently. In fact, more than 70 individuals had pled guilty to participating in a social security disability eligibility conspiracy to obtain at least $14 million in fraudulent benefits back in 2014. This is exactly why the GAO was asked to review the Social Security Administration’s fraud risk management.

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Thursday, May 18, 2017

New Health Insurance Marketplace Coverage Options Get Thinner as Providers Exit ACA Marketplace

The continuing saga of the proposed changes with the Affordable Care Act is putting a lot of things in limbo, and a lot coverage providers are running for cover. Case in point, the latest company to back out of the marketplace is Aetna.

The insurer has two remaining states in their service list, namely Nebraska and Delaware, but it won’t be for long. The company has recently confirmed that they will no longer be entering back into the marketplace to sell individual health plans for the said states, a move which comes shortly after dropping Virginia from their 2018 service list.

Earlier in the year, the company had already declared that they will be letting go of Iowa. Originally, Aetna held as much as 15 states where they offered Obamacare policies. By mid-2016, however, they started to pull out from 11 of these. With the last two states now being dropped as well, it signals the official and complete exit of the insurance company from the ACA marketplace by 2018.

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Wednesday, May 17, 2017

Affordable Care Act Marketplace Changes May Leave Some States Without Insurers

Over the past couple of months, insurers have been jumping ship from the Obamacare marketplace that has been under attack even more aggressively in the past year. While the changes are to be expected following the change in the administration, what remains unclear is whether or not the people relying on their ACA coverage will continue to have insurance coverage.

Coverage Woes

As it stands, there are already a lot of problems concerning the viability of the Affordable Care Act Marketplace. In certain states like Iowa, a lot of insurers have already stepped out of the picture, while others are about to ease their way to the exit. What this means is that locals are going to be hard pressed to find an alternative, or a backup plan, to keep their coverage intact for as long as possible.

In the meantime, the lawmakers are still struggling to come up with a suitable replacement that will be approved not only by the House but also by the Senate. So far, the two houses appear to be badly out of sync with each other when it comes to health care.

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Monday, May 15, 2017

A Look at the Facts on Social Security Disability for Children and Privatization

Whether you believe in privatization of social security or not, the fact remains that it would cause significant changes within the revenue cycle management industry. The general public don’t hold out much hope when it comes to receiving benefits from the program. In fact, only 37% of those questioned believe somewhat that the social security system will benefit those in the future as much as it does today.

What does a privatized social security system look like, and how will this affect social security disability for children and countrywide revenue cycle management processes?

How is Social Security Being Privatized?

The general idea for a privatized social security system is that instead of paying taxes and ultimately receiving benefits in the future, people will make monetary contributions to their own privately managed savings accounts.

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Friday, May 12, 2017

Employ More Assistants to Improve Hospital Revenue Cycle Management Processes

Recent years have seen numerous changes headed towards hospital revenue cycle management processes, including the introduction of ICD-10 and changes to Medicaid and Obamacare. Because of this, healthcare facilities need to become more creative in how they manage these issues while still maintaining focus on keeping costs low.

Although it may initially seem counterproductive, the truth may be that increasing the amount of assistants employed across the hospital setting may be the answer to streamlining revenue cycle management processes.

Keep Billing Specialists Focused on Their Role

If your healthcare facility expects billing specialists to speak to patients about denied claims, outstanding balances and collect the copay, you may need to rethink this model. Instead of using the costly time of specialists for these matters, leave them to focus on completing coding on patient documents instead.

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Wednesday, May 10, 2017

The Advent of Online Billing Portals Spurs Revenue Cycle Management Services to Adjust

How familiar is your health care facility with the primitive payment options available to patients? If you only have a simple username and password system for a third party payment site, you’re already behind the times when it comes to new technologies that streamline revenue cycle management services.

Recent evidence reveals concerning trends in healthcare collections. Patients are now expected to assume more responsibility for the cost of their health care, which means hospitals are required to be much more upfront about the portion of the bill each person is expected to pay. While patient satisfaction may increase, many bills might go unpaid and healthcare facilities might begin to suffer if suitable processes aren’t in place to collect these payments.

Some Background on Online Payments

Due to concerns over patient confidentiality, online payment methods inherently involve complex or hardly simple procedures. A common method involves an online form completed by patients who convey their payment details on the form. The snarl in this method develops when a revenue cycle management worker must then re-enter these details to manually process the payment.

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Monday, May 8, 2017

What is Revenue Cycle Management Going to Look Like with Increased Consolidation?

Today’s news stream brims with discussions around the increased levels of consolidation in the U.S. healthcare industry. Meanwhile, many healthcare providers are now asking, “What is revenue cycle management going to look like with a rise in consolidation?”

To understand any coming changes, the recent trends in consolidation need to be examined carefully by providers and their revenue cycle management companies.

The Shift to Value Based Care

National healthcare expenditures continue to rise, currently at a level of 18%, compared to only 12.5% in 1990. The onus now rests on healthcare facilities to find a way to combat this rise. Generally, they are countering with significant consolidation of services.

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Wednesday, April 26, 2017

Social Security Disability Eligibility Cuts Treating-Physician Rule, Keeps Appeal Waiting Times Long

The Social Security Disability program benefits millions of Americans, no matter how old or young they are. However, a new rule imposed by Social Security recently may make it harder for any patient of any age to be approved for social security disability eligibility. This is because the administration has recently introduced a new rule where doctors’ reports would no longer be used to determine an individual’s eligibility to receive benefits.

Rule changes such as this present additional challenges to hospitals and healthcare institutions trying to determine if their patients qualify for disability benefits.

Social Security Administration Announces an Update to Its “Treating-Physician Rule”

The Social Security Administration has just said that it will now eliminate the use of what is known as the “treating-physician rule” as a basis of disability eligibility. The said rule refers to Social Security’s previous practice of giving a doctor’s report significant weight in supporting a person’s disability entitlement. Previously, Social Security adjudicators are required to consider evidence of disability as presented by the medical professional treating the claimant.

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Monday, April 24, 2017

New Bill Offers Disability Social Security Beneficiaries a Pathway Back to the Workforce

Americans who are on disability social security may soon find themselves back to work the moment they are able to. A new proposed bill in Congress aims to give recovering beneficiaries a pathway back to the workforce. This would give them the chance to start their life over after going through a series of medical treatments and recovery.

Earlier this year, Rep. French Hill, R-Ark. had introduced the Social Security Disability Insurance Return to Work Act of 2017 in the House of Representatives. On the other hand, Senators Tom Cotton, R-Ark.; Mike Lee, R-Utah; and Marco Rubio, R-Fla. introduced a companion bill in the Senate.

Hospitals and healthcare facilities need to be aware of these proposed changes so they can properly assess their patients’ eligibility for the program.

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Sunday, April 23, 2017

Why Eligibility for Social Security Disability Remains a Challenge for Some

The difficult process of filing for benefits is causing the social security disability program to fail many of the people it’s supposed to serve. A combination of administrative inadequacy and far too rigorous requirements have only managed to deny benefits to some deserving claimants. This provides hospitals and healthcare institutions with an opportunity to improve their revenue cycle management processes by helping their patients with SSDI eligibility problems.

Background on SSDI

The social security disability program was created to help people who are unable to work due to a disability. In the event that able-bodied individuals suddenly become injured or fall ill, they can have some financial relief to look forward to.

These benefits are also extended to children who suffer from disabilities or conditions that prevent them from fully functioning. The extension of the benefits to disabled children is meant to relieve parents of the cost of providing for whatever special needs they may have.

This, however remains to be only an ideal for some people. In fact, even if they have been religiously contributing, they may still find it difficult to meet the requirements for eligibility for social security disability. Read more on this article:

Friday, April 21, 2017

The Affordable Care Act Marketplace Is Under Threat as Insurers Stand to Lose Federal Subsidies

All over America, uncertainty continues to loom when it comes to the future of healthcare insurance. In recent months, the Republican party has worked hard to repeal and replace the Affordable Care Act or Obamacare. Their version of Obamacare, dubbed as the American Health Care Act, presented challenges to both individuals and healthcare facilities with possible changes with their health plans.

However, this attempt failed to secure enough votes to introduce a new healthcare system being supported by President Donald Trump and several members of the Republican party. Following this, President Trump said that the Affordable Care Act would stay in place in the meantime as the GOP carefully plans how best to approach the overhaul of the U.S. healthcare system.

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Wednesday, April 19, 2017

Work Requirement May Soon Help Determine Eligibility for Medicaid Benefits

For quite some time now, Medicaid has been the most widely available source of health coverage for people living across the United States. Through this program, over 72.5 million Americans, particularly disabled individuals, pregnant women, children, and seniors, were able to gain affordable health coverage. Due to recent events, however, many of them are at risk of not being able to avail of Medicaid when they would need it most.

After the recent collapse of the proposed American Health Care Act or AHCA, there has been increased interest among the Republicans to add work requirement into the eligibility for Medicaid. In fact, Department of Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma both sent letters to various state governors, giving them greater flexibility when it comes to approving Medicaid Section 1115 waivers. At the same time, these include a number of work-related proposals. 

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Tuesday, April 18, 2017

CMS Looking at New Health Insurance Marketplace Coverage Options by 2018

Even as the Affordable Care Act (ACA), otherwise known as Obamacare, survives to live another day, the seeds of doubt have already been planted in the minds of the insurers. Is it on its way to a more sustainable future, or is this but a temporary reprieve from the threat of repeal and removal?

Waiting in the Dark

For most health insurers, it’s a lot like a waiting game--and in the dark, too. The new administration had been very vocal about providing a new model for the health insurance marketplace, but this confidence was doused by failure to gain approval from Congress. As a result, many of the providers are choosing to tread lightly, opting not to commit fully about staying on in the program, at least until the new administration does offer a clearer stand about what it intends to do about healthcare policies. Read more on this article:

Monday, April 17, 2017

Avoiding Denied Claims is Crucial to Good Hospital Revenue Cycle Management

According to a report by Relay Health Financial, large hospitals in the Northern Plains have higher average claim denial rates compared to other areas in the country at a surprising 10.58%. The report defines large hospitals as facilities that host 250 to 400 beds. The percentage was derived by comparing the claims dollars that were denied relative to revenue successfully billed on the claim.

The South Central region, meanwhile, topped the list among mid-sized hospitals (100-250 beds), with a denial rate of 8.82%. The region also ranks second among large hospitals, registering a denial percentage of 8.8%.

Of course, as any healthcare executive knows, denial rates are simply part of business. After all, insurers closely scrutinize each claim to see if they should indeed pick up the tab for the patient. However, keeping denial rates to a minimum is a crucial part of hospital revenue cycle management. After all, when claims are denied, unpaid bills have a higher chance of becoming potential bad debt.

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Wednesday, April 12, 2017

Medicaid Expansion Shown to Improve Healthcare Revenue Cycle Management

Operating a healthcare facility is no mean feat. For hospital executives, the task involves not only providing excellent medical care to patients, but it also means keeping a business afloat. After all, a hospital is an expensive venture to run—almost all of its manpower are highly skilled professionals, and the facility uses advanced equipment to help diagnose and treat ailments.

As such, keeping a healthy bottom line is crucial to any hospital’s survival. However, unpaid medical bills prove to be an all too real threat. According to a report from The Tennessean, about half of all hospital bills go unpaid. Healthcare executives know that potential bad debt can hobble their facility’s ability to deliver excellent care to the infirm.

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Tuesday, April 11, 2017

Envisioned New Tax Plan May Affect Even Social Security Disability for Children

The supposed ACA replacement may have fallen through, but people relying on social security shouldn’t heave a sigh of relief just yet. A new tax reform is being worked on, and analysts are purporting that this might affect social security itself. The uncertainty has hospitals and healthcare facilities worried about the continued eligibility of many of the patients they serve.

The Status Quo

The payroll tax is similar to income tax, but the main difference between the two is that the former funds employee benefits, while income tax is what is owed to the government. In the current set up, the payroll tax funds Social Security and a portion of Medicare as well. This tax is generated by deducting a percentage of the worker’s wages, with the employer contributing an equal amount. Read more on this article:

Monday, April 10, 2017

What is Revenue Cycle Management in the Age of Healthcare Consumerism?

For the longest time, the healthcare industry’s status quo has been more or less intact. Yes, technological advances have been introduced, but the way hospitals conducted business was mostly the same: patients come in, they get treated, then they get billed.

However, public policy driven changes have led to a shift in the way patients receive medical treatment. For one, there are more walk-in clinics and ambulatory care centers that offer many of the services one could find only in a hospital years past.

Moreover, more patients are opting for high deductible plans from the health exchanges, which means that more of their medical costs are being paid out of pocket. Many feel that this is a more cost-effective option, especially those who are relatively healthy and very rarely get sick.

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Friday, April 7, 2017

In an Era of Healthcare Consumerism, Revenue Cycle Management Companies Help Hospitals Stay Afloat

For the foreseeable future, the Affordable Care Act or ACA is here to stay. With its continued implementation, the law continues to change the healthcare landscape as Americans know it.

More specifically, the landmark law has spurred a change in the way patients look at—and acquire—healthcare services. According to a 2016 report by InstaMed, healthcare providers saw a 74% increase in patient financial responsibility.

Data shows that during the 2016 open enrollment period, 90% of the 12.7 million people who got coverage from the health exchanges got a high-deductible plan. Compared to 2006 figures, this represents a 225% increase in out-of-pocket expenditures during hospital trips.

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Wednesday, April 5, 2017

To Reverse the Rate of Unpaid Bills, Outsource Your Revenue Cycle Management Services

Over the tenure of the American Health Act (ACA), some observers have blamed it for the rise of unpaid patient bills at hospitals. Following the failure of House Republicans to replace the ACA with their own American Health Care Act, hospitals have come up with a new strategy to deal with a rising volume of unpaid bills. They bill the patient before any medical service is actually done. Hospitals are forced to try out this option because insured Americans are still required to spend thousands of dollars before their actual insurance payments ensue.

The ACA Has Led to Greater Unpaid Bills Over Time

In recent years, the ACA extended insurance coverage to as many as 20 million Americans. Initially, this allowed hospitals to reduce debt from uninsured patients who had originally been unable to pay their medical bills.

As time went on, however, more Americans on ACA plans have chosen insurance with low monthly payments, resulting in a trade-off with dire consequences. Patients now have to deal with higher out-of-pocket costs the moment they need medical care. As a result, hospitals must deal with a higher percentage of unpaid bills as patients continue to face the same dilemma over and over again when it comes to healthcare plans. Read more on this article:

Monday, March 13, 2017

Five Month Waiting Period for Disability Social Security May Soon Be Scrapped for ALS Patients

Currently, disability social security policies require a five month waiting period for the approval and release of disability benefits to victims of ALS (Amyotrophic Lateral Sclerosis or Lou Gehrig’s Disease). The length of the waiting period can be attributed to the sheer volume of applicants and the actual process required by the application.

Depending on where you sit in the queue, you sometimes can’t even be guaranteed that you will be approved within this waiting period. Any back payments can therefore be made past five months.

Immediacy of Need

For many citizens suffering such a disability, this amount of time may prove to be too long and perhaps, too late, especially when they are seeking treatment. For example, patients of ALS suffer from progressive symptoms, such as difficulty in walking, constantly tripping or falling and general weakening of the muscles. Eventually, they may even lose the capability of holding their head up, which affects breathing, speaking, swallowing and chewing. Read more from this blog.

Friday, March 10, 2017

Challenges to Gaining Eligibility for Social Security Disability for Rare Diseases May Intensify

With the impending repeal of the ACA (aka Obamacare), everyone is on guard and trying to figure out what’s going to happen next with their insurance coverage. If reports on supposed amendments are true, then a substantial number of covered individuals under the ACA will lose their coverage.

Among the sectors concerned about these changes are those suffering from rare diseases. As it stands, it can already be challenging to gain eligibility for social security disability on account of a rare disease. How much more difficult it will be under the new system is a major concern for those afflicted by a rare disease.

Status Quo

Under the current system, being granted benefits for disability under the social security system requires proof that the individual is suffering from total and permanent disability. Typically, it can be a severe physical or mental disorder lasting anywhere from a full 12 months. In determining the level of disability, the SSA refers to the “Blue Book,” a compendium of all SSA-approved disorders and their corresponding requirements for qualification. Read more on this article.

Thursday, March 9, 2017

Gaining a Deep Understanding of Your Patient’s Eligibility for Social Security Disability

In 2015, the Social Security Administration reported that the agency has paid disability benefits to more than 10.2 million Americans. In total, disabled members and their beneficiaries received approximately $11.4 billion in that year alone. In terms of the type of disabilities, nearly 31.7 percent have been diagnosed with musculoskeletal disorders.

Every month, these disabled individuals and their families are receiving supplementary pay of about $1,165 on average. At present, the SSA continues to cater to the concerns of its members as the agency strives to upgrade to a better system.

Overview of the Application Process

When a patient files for Social Security disability insurance, the medical provider’s task is to verify the extent of his disability. This may be supported through medical diagnoses, laboratory results, psychometric tests and other documents. Such evidence must be able to prove his physical and/or mental capacity to do work or resume work. Read more from this blog:

Eligibility for Medicaid and Health Coverage Itself Up in the Air as ACA Repeal Looms

It’s been a tense past couple of months as efforts to repeal the ACA, dubbed Obamacare, appears to be more imminent than ever. At this point, people are now simply wondering when it will happen as opposed to whether it will happen. With the resounding support of the Republican majority in Congress, its repeal is most certainly guaranteed already.

Beyond the abolishment of the ACA, however, the more pressing question for all those affected centers on its replacement. Without the ACA in place, what kind of system will be introduced to fill its void?

Filling the Gap

There are no concrete plans announced as of yet, although there have been plenty of talks pointing to what the changes could be. Included in the possible revisions is the removal of the highly contested income-based tax credit of the ACA. In its stead, an age-based tax credit system might be invoked. In this new system, it wouldn’t matter if you are a high or low wage earner. You’ll be getting coverage and benefits equally, as long as you meet the age bracket requirement.

Another looming issue drawing much concern from those currently insured under the ACA is the report of anticipated revisions to Medicaid. A couple of days before February ended, a “discussion draft” was leaked to the public. The draft was supposedly a work in progress by the GOP. However, it conveyed a very telling picture of what will most likely transpire once the ACA is repealed. Read more from this blog.

Wednesday, March 8, 2017

Current Status and Possible Changes: Important Notes on Social Security Disability Eligibility

Hospitals should assist individuals who work hard to earn a living but get disabled to process their claims for Social Security Disability benefits. As part of the mission of the Social Security Administration (SSA), disabled members, despite their current health condition, still have the chance to receive benefits so they can provide for their family’s needs.

For more than 60 years, the SSA has implemented the Disability Insurance Program to dole out cash benefits for members in need of assistance. Hospitals and healthcare facilities also play a crucial role in this process. By providing accurate medical data on each patient, they bridge the gap between the SSA and members who seek benefits.

How Helpful Has the Program Been?

Of the more than 65 million members that are under Social Security in 2015, more than 10.2 million people have reaped disability benefits. By the end of the year, the total amount that was paid out to disabled workers and their beneficiaries have reached more than $11.4 billion. Read more from this blog:

Folks Keep a Keen Eye Out for New Health Insurance Marketplace Coverage Options

In 2013, the Department of Labor rolled out a memorandum explaining to its staff the new health insurance marketplace coverage options for the yet-to-be-enacted Affordable Care Act. The memo reassured everyone that the marketplace would be a “one-stop-shop” experience so that customers may find the health insurance option best suited for them.

Apart from that, a communication was issued specifically to employers offering health coverage to their employees and another to companies unable to fast-forward in response to ACA. The same department will now see the forms and guidelines related to these communications expired.

Originally, the purpose for the guidelines and forms was to compel all employers to coordinate with the proper authorities so that their employees could select their own health coverage. Now that the ACA is at risk of being repealed, guidelines such as those from DOL are being rendered moot.

The Waiting Game Begins

It’s not just employers under the governance of the Department of Labor that are awaiting for new word on new marketplace options. States and local communities are also becoming anxious, if not nervous, as the ACA repeal becomes more likely day-by-day and without a replacement in sight.

When the repeal is enacted, among the features possibly affected is the inhibition of coverage denial in the marketplace for health related reasons. The basis used for premium costs may also be soon revised. Under the ACA, factors such as gender, age, pre-existing conditions, health status, coverage duration, small employer specifics and industry, as well as, claims history, cannot be used in the basis of cost computation. Read more on this article.

Tuesday, March 7, 2017

Moving Forward: Possible Effects of New Health Insurance Marketplace Coverage Options

At the end of January 2017, the open enrollment for health insurance enrollment through Obamacare has closed. To date, while many recognize the need for medical insurance, there are still a number of people who are hesitant to sign up for it. Not only that, but with President Trump’s victory comes rumors of drastic changes to or possible total repeal of the Affordable Care Act (ACA).

The Promise of Obamacare

Since 2010, the Affordable Care Act (ACA), fondly called Obamacare, has aimed to make health insurance simple to manage and easy to obtain for every individual. As of 2016, there are more than 11.7 million people who have found better and more affordable health insurance plans through the marketplace. This was an impressive improvement over the 47 million uninsured people prior to the implementation of the new health insurance marketplace.

Possible Futures for the ACA Marketplace

A few weeks after the national elections, there was a buzz about the possible repeal of the ACA. Now that President Trump has taken office, lawmakers under his administration have already been pushing for their own versions or revamps of the Obamacare program. For instance, Rep. Tom Price proposed increasing the premiums or contributions of each individual for their insurance accounts. He would like these paying individuals to receive tax credits so they can have enough funds set aside for their medical expenses. Read more from this blog:

Monitoring the Metrics of Healthcare Revenue Cycle Management Poses Benefits to Revenue Stream

Amid high-deductible health plans and healthcare consumerism, providers are experiencing changes in revenue sources. However, many of them still face challenges in cash flow and payment collection. According to one study, although hospital receiving offices collect from 35% of their patients, the total amount accounts for only 19% of patient financial responsibility.

One way to keep the cash flowing is to monitor revenue cycle management metrics. With regular monitoring, healthcare organizations and systems create the ability to gain maximum reimbursement and improve the assessment of their billing departments. These metrics should be carefully selected and tracked to inform providers of where their flows currently stand and whether they are heading in the right direction, based on their goals and objectives.

Rate of First Pass Payment Recovery

Experts say that organizations should be receiving a first pass recovery rate of at least 80% to ensure that they are able to close out receivables accurately and on time. Monitoring this metric allows providers to determine efficiency in terms of getting full payment for insurance claims at first pass. Due to submitting claims a second time around wastes time and money, hospitals must strive to collect on the initial submission. They should focus on checking whether claims are processed instantly and closed on time. Read more on this article.

How Social Security Disability Eligibility May be Affected by Changes to Medicare

One of the benefits of Medicare comes from part D, which provides drug prescription coverage to those enrolled. However, in 2017 the number of different plans available is likely to drop to its lowest level since 2006. Those enrolled in Medicare will have around 22 prescription drug plans to choose from, the problem being that these plans vary widely in terms of specific drugs they cover. This means that those who need specific medication may find it difficult to tailor their Medicare package to suit their needs.

Because it has larger budgetary impact at a federal level, the government is looking to revise Medicare too. These potential revisions include trying to move patients toward insurer provided Medicare Advantage plans rather than the traditional Medicare program, as well as introducing a voucher system cap, which would shift the financial burden of rising healthcare costs onto participants.

How it will Affect Social Security Disability

Since many people who are eligible for Social Security Disability benefits are also enrolled with Medicare, they could find themselves unable to get the prescription drugs they need. While the benefits from Medicare don’t kick in until 24 months after you have met the Social Security Disability eligibility criteria, it’s still something that could have a large impact on the number of non-payment patients in your hospital. Read more from this blog.

Monday, March 6, 2017

Sign-Ups for 2017 Now Closed: What to Expect from the Affordable Care Act Marketplace

The open enrollment period of the Affordable Care Act, otherwise known as Obamacare, has come to a close, recording a noticeable dip in the numbers compared to what was initially expected. According to the previous administration, they were set to sign up at least a million people during the final week of the open enrollment period. It missed that mark, however, and the total number of sign-ups was pegged at 9.2 million. This reflects a 4% decline from the 9.63 million recorded people at around the same time last year.

Despite this minor setback in sign-up numbers, and despite the worries about the future of Obamacare, those who did enroll with the program can still expect to be offered the full service guaranteed by it. Experts note that, confusion in policies aside, people should still go for the opportunity to be covered, especially since the Affordable Care Act marketplace this year has various health plans and subsidies in place.

Hospitals and other institutions that will inevitably be affected by the shifts and movements in the implementation of Obamacare should be equally alert so as to ensure a smooth continuity of service delivery to their patients. Read more from this blog:

A Host of Reforms to Social Security Disability for Children Can Improve the Lives of All Involved

Despite the number of children in need of healthcare assistance, social security disability and other public programs remain a minor topic. According to statistics, around 11.2 million children have special healthcare needs. That’s 15% of the child population in the country, with 73% of that percentile coming from either low or middle income families.

These children, especially those suffering from Down Syndrome, Autism and Cerebral Palsy, require nursing care at home, counseling and therapies to improve their living condition. Without stable finances, they just could not afford proper medical care.

With social security disability for children (SSDI), handicapped children in low income households are granted financial assistance for their medical needs. In fact, the number of people receiving SSDI benefits has increased over the years. Read more on this article.

Revenue Cycle Management Companies Discuss the Likely Impact of the Proposed ACA Repeal

Many Americans, healthcare facilities and revenue cycle management experts are preparing for the possible effects of the proposed changes in the country’s healthcare policy. In recent years, the Affordable Care Act (ACA) have expanded its health coverage to at least 20 million people. It also offers insurance subsidies and other provisions, as well as, takes out insurance lifetime caps and includes pre-existing conditions. By making it easier for Americans to get insured, the ACA provides easier access to medical care, regardless of their status.

Under the new administration, however, there’s a possibility that the ACA could be repealed and replaced by new policies. These plans are keeping healthcare facilities on their toes. With the impending repeal expected to affect millions of Americans relying on healthcare insurance, these changes will have a direct effect on healthcare revenues as well. Read more from this blog.

How The Affordable Care Act Marketplace Would Be Affected by a Shift in Health Insurance Tax Credits

As a result of the many reforms that are taking place within the healthcare marketplace and with health insurance tax credits, it’s unsurprising that many patients are left confused; some may even find themselves without medical insurance.

What if Tax Credits are Removed or Lowered?

Currently, an important part of discussions surrounding the repeal and replacement of the Affordable Care Act is focused on the type and amount of subsidies that help people afford health insurance. Through the Affordable Care Act, households are rewarded tax credits based on various criteria, including family income, the cost of insurance locally, age and whether or not premiums have increased annually. Under the current Affordable Care Act, households with lower incomes receive higher tax credits.

Under new plans, however, the tax credit offers will not vary with income. In effect, this gives those with higher income levels higher tax credits. Additionally, new plans will not vary tax credits by location. In areas where premiums are higher, no higher tax credits will be given. Read more from this blog.