Editor’s Note: This blog entry was originally published on June 28, 2016, and was updated on July 29, 2020.
Patient payments and billing are in a constant state of transformation. Government regulations, insurance involvement and new technologies drive continual change in the business of delivering healthcare. In our infographic below, learn about the highly complex world of medical payments.
Medical Payments Complexity
Why are medical payments becoming so complicated?
- The Affordable Care Act - Healthcare legislation can affect aspects of medical payments, such as by changing the number of private health plans patients purchase.
- HIPAA Compliance - HIPAA, which stands for Health Insurance Portability and Accountability Act, is a rule that sets "national standards for the protection of individually identifiable health information by three types of covered entities: health plans, health care clearinghouses, and health care providers who conduct the standard health care transactions electronically."
- New Technologies - New technologies, such as telehealth appointments, often necessitate new or altered payment methods.
- Security and PCI - Any entity who processes, stores, or transmits credit card data (including medical practices) must follow PCI standards to help to ensure that cardholders' credit card data is protected once it is given.
Mergers and Acquisitions
Mergers and acquisitions among healthcare practices are becoming more common. This is due in part to economies of scale in the face of declining payer reimbursements and increased costs. Mergers and acquisitions often result in new processes and systems for payments. Practices may upgrade their point-of-sale (POS), start accepting mobile payments, or begin offering more payment methods in addition to the traditional credit card.
- Affordable Care Act - Consumers purchased 2x as many private health plans in 2015 vs. 2014.
- Average Deductibles Increase - Between 2011 and 2016, average medical deductibles have increased nearly 50%.
- Employee Co-Pays - 73% of workers covered by medical plans must provide co-payments at the time of service.
- Consumers Paying More for Healthcare - Between 2011 and 2016, there was a 9.3% overall growth in patient spending
- Increase in Billing:
- 10% Physicians
- 7% Hospitals
Medical Payments are Going Mobile
- In 2016, 40% of consumers had used mobile devices to make a payment.
- Based on gross purchases, mobile payments are expected to grow nearly 200% between 2016 and 2021.
Payment Choice and Security
A majority (67%) of patients prefer a choice of payment methods. Payment security is also a concern for patients, who worry about:
- Breach of financial information
- Compromise of personal data
- Hacker infiltration
Who’s Minding the Practice?
Doctors rarely handle payments. Payments can be handled by staff or contracted services for a medical practice. Some of the roles that handle payments can include:
- Office Manager
- Billing Services
- Collections Firms