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Why I Don’t Want to Pay My Doctor: A Patient’s Perspective

A recent visit for an annual physical left me feeling angry, cheated, and worst of all, broke. After expecting a twenty-dollar co-pay, I was shocked to hear the administrator at the front desk utter, “And, today, you owe, $275.” My eyes grew big, almost popping out of my head, “Excuse me?” I questioned. “I’m sorry; you haven’t met your deductible yet” she explained with a smile. “I’ve seen worse,” she added. I was confused and overwhelmed by the various thoughts flooding my head. Wait a minute, I have great insurance, an awesome job, and set that money aside for a fun weekend trip to Charleston, not to give to you, I thought to myself. Of course I couldn’t tell her that, so (like a responsible adult), I reluctantly handed over my debit card, turned around, and waited to see my doctor. I felt slighted in some way. Why didn’t someone tell me this before I booked the appointment? Why isn’t my insurance paying for this? Do I really owe that?

Surprise Bills Are the Worst Kind. While $275 may not seem like a lot to some, it was a shock to me, and something I wasn’t prepared for. This is an all too familiar story and a large reason why medical practices need to increase patient engagement and communication amongst practitioners. It’s beneficial to set clear expectations in regards to the patient’s financial responsibility before the appointment is even scheduled. It’s vital for everyone involved – the insurance companies, the medical practice, and especially the patient to understand what is owed. Patients are consistently confused about what they owe. Last year, 42% of consumers said they were confused by the bills they received from their providers.

If I don’t understand it, do I still have to pay it? Who wants to pay a bill when they aren’t sure they “really” owe what is listed on that bill? A friend of mine who recently had a baby, shared that she received multiple bills from various doctors. Now, eight months later, the bills are still being altered, corrected, and worked out by her insurance company and the hospital. Meanwhile, she’s been sent to collections, and now has a healthy baby and an unhealthy financial situation. According to the Medical Billing Advocates of America, 8 out of 10 hospital bills contain mistakes.

I have to pay for my dinner, but not my doctor? Due to a change in FICO scoring, medical bills now weigh less on your credit score, thus patients have even less of an incentive to pay their doctors. Working for a medical billing software company has shown me how much patient debt some practices are writing off. Meanwhile, doctors are becoming banks that provide financing for patients that are trying to pay their medical bills. Sometimes it takes patients years to completely pay their doctors, while the patients who are unwilling to pay their medical bills, or just simply can’t, are written off as bad debt with little to no repercussions for lack of payment.

Give Me Options. I want to pay my bill, but I’d rather do it online. My phone bill, my rent, my car payment, and even my power bill get paid online. Just like choosing an affordable phone plan, residence, automobile, or setting up fixed utility payments, I should be able to do the same with my medical bills. I enjoy the convenience of setting up automatic payments on a schedule that I choose. Unless it’s a personalized greeting card, I absolutely hate getting mail, where most of it ends up in either the trash or the shredder. I’m not alone! 93 percent of consumers would pay online through their provider’s or a health plan website. Providers need to understand, as a patient, we need multiple payment options and most of us, would rather pay you online.

The Struggle is Real. Even with insurance, many patients are struggling to pay medical bills. The Kaiser Family Foundation reported that one-third of Americans struggle to pay their medical bills. With increases in high deductible plans, the rising costs of prescription drugs (nearly 123.7% from 2000 to 2013), and stagnating income, it’s no wonder I’m more likely to go into bankruptcy from my medical bills than by supporting my shoe fetish. High deductible plans aren’t going away. If you don’t currently have payment plan options for your patients, you need to. There are many great options available to help patients pay their medical bills. Practices need to start offering these options to their most difficult payers; their patients. Just be sure to vet out these programs to ensure they have your patient in mind, and won’t hit them hard with high interest fees if they default on payments. Imagine recently launched ImagineHonorCare®, a flexible, interest free patient payment plan option. As a patient, and someone who works closely with providers and medical practices, this is a wake up call for providers to start offering patients more payment options, continue increasing patient engagement, and provide patients with the most accurate explanation of what they owe.

Now, let it be clear that I’m not saying it's acceptable to not pay your doctor. My goal is to provide a unique insider’s perspective from both a patient who has experienced frustrations and confusion surrounding medical bills, and as a professional, whose daily job is helping providers and medical practices with patient collections.

To find out more about offering patients a better way to pay, schedule a demo of ImagineHonorCare®, or contact:

Joya DiCristo
This email address is being protected from spambots. You need JavaScript enabled to view it.
704.887.1475

Resources: 

Instamed; Trends in Healthcare Payments Fifth Annual Report 2014: https://www.instamed.com/wp-content/uploads/Trends-in-Healthcare-Payments-Annual-Report-2014.pdf

Medical Billing Advocates of America; Why you Need a Hospital Bill Review: http://billadvocates.com/resources/need-hospital-bill-review/

FICO; FICO Score 9 Introduces Refined Analysis of Medical Collections: http://www.fico.com/en/newsroom/fico-score-9-introduces-refined-analysis-of-medical-collections

Kaiser Family Foundation; Medical Debt Among People with Health Insurance: https://kaiserfamilyfoundation.files.wordpress.com/2014/01/8537-medical-debt-among-people-with-health-insurance.pdf

Beckers Hospital CFOl; 50 things to know about healthcare costs: http://www.beckershospitalreview.com/finance/50-things-to-know-about-healthcare-costs.html

American Journal of Medicine; Medical Bankruptcy in the United States: http://www.amjmed.com/article/S0002-9343(09)00404-5/abstract

HonorCare®; Honor Your Health Payment Plan; http://www.imagineteam.com/healthcare/software/patient-pay-system

Top Class Actions; GE Capital Retail Bank Ordered to Pay $34.1M in Care Credit Refunds: http://topclassactions.com/lawsuit-settlements/lawsuit-news/31584-ge-capital-retail-bank-ordered-pay-34-1m-carecredit-refunds/

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Radcom Associates, Ltd. Selects ImagineSoftware as Medical Billing Provider

Charlotte, NC – Technology Partners, Inc. (dba ImagineSoftware), a leading provider of medical billing technology, announces that a new client, Radcom Associates, Ltd., has chosen the Imagineradiology™ practice management suite for its billing and collection needs.

A multi-specialty, multi-state medical billing company based outside of Pittsburgh, Radcom provides services to more than 70 physicians who bill over 850,000 procedures annually. After careful consideration of other solutions within the marketplace, Radcom selected Imagine as the new centerpiece of its billing operation due to the need for an all-encompassing practice management system that could provide seamless integration capabilities with existing client services.

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PBS West Interview

PBS West is a small billing company specializing in radiology and also several hospital-based practices in our regional market. It is so easy to be taken with the next generation computer systems, which Imagine very much represents. 

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ImagineSoftware Unveils Imagine EFX for Global Billing Performance

Charlotte, NC - ImagineSoftware, a leading provider of medical billing solutions, announces the first look of Imagine EFX, the next version and 11th generation of its practice management suite.

Developed on a completely interoperable framework, Imagine EFX allows the system to be expanded on its secure, privacy-centric and ubiquitous platform.  EFX methods include browser-based, virtualized, native app, and enterprise presentation.  All methods are designed for simultaneous, multi-user, multi-mode environments and performance, providing optimal experience and efficiency to Imagine users from a variety of locations in real-time, all with advanced quality, speed, and security.

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ImagineSoftware Adds Medical Software Company CPU

ImagineSoftware, a leading provider of healthcare billing software, today announced that cloud-based medical and professional billing software solutions provider, CPU Medical Management Systems (CPUMMS) joins the Imagine team. The combined company will be the market leader with the single largest footprint of radiology billing softwarewith an expanded presence across multiple healthcare specialties

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Imagine Practice Management Software

ImagineSoftware's Practice Management Software improves practice cash flow, streamlines the billing processes and provides real-time practice KPI's. Our advanced billing software leverages your staff capabilities for a true “new generation billing" effort. Designed to further enhance the advantages of ImagineRadiology®Imagine's Practice Manager meets the needs of medical practices and billing companies by improving practical applications within the billing / collections system, including easy to use GUI, grouping of like-information and class together, automatic adjustment of screen size and resolution, and recent account retrieval of patient and practice information.

ImagineMedical Practice Manager is the industry's first intelligent multi-platform channeling practice management system. The core module of IMAGINEradiology®, Practice Manager, offers integrated radioloy billing features including: automated denials, radiology workflow, medical billing charge central, HIPAA audit trails, document management & archiving, denial mitigation, flex reporting and more.
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Healthcare Excellence Despite Lower Reimbursements

Bridging the Gap and Meeting Demands

Healthcare reform ups the ante in terms of expectations, attempting to measure (and pay) in a world of quality, where patients are “cured” the first time around and the effectiveness of their physicians determined by whether they accomplish that goal. Value-based compensation models, while still functionally vague, are the intended mandate and represent a quantum change from current fee-for-service models.

Bridging the GapThe “new” model of healthcare comes on the heels of recent reimbursement cuts, the implementation of “5010” (the new format for standard electronic Health Insurance Portability and Accountability Act transactions), the threat of penalty for failure to submit quality data codes compliant with Physician Quality Reporting System (PQRS) measures to the Centers for Medicare and Medicaid (CMS), confusion regarding changing Meaningful Use requirements, an often hostile environment of Recovery Audit Contractor (RAC) audits and even more confusion over how to function with future payment systems. In our new world, the quality of healthcare will improve based on objective measurement and the “value” of the patient experience, all at lower cost for those paying the bill.

Better healthcare for less cost? The demand for more service, higher standards of accountability (while at the same time simplifying administration), and increased levels of compliance reporting usually go hand in hand with higher costs. Practices are rapidly facing the need to upgrade technology and personnel skills, with perhaps a greater reliance on support from consultants and professional organizations to help them navigate the waters.

This type of contradictory, disruptive messaging tips the balance of certainty and stability, puts us on high alert, and allows for fear, uncertainty, and doubt to set in. Some of the credible surveys conducted in 2011/2012 show physician morale at an all-time low, with many providers considering the safety of employment over practice ownership and others even considering a change in career.While this should come as no surprise given an increasingly hostile business environment, it would be unfortunate and further add to the predicted physician shortage in the future. In fact, solutions to this crisis are actually within reach.

Radiology is usually viewed as a “behind the scenes” specialty, where contribution to the patient’s circle of care is consultative and supports those physicians with direct patient contact. While radiologists could in theory support the concept of “value” in medicine, they in fact have little control over how their interpretations are used to drive improved outcomes. At the same time, as quality becomes the watchword, insurance companies in some parts of the country are attempting to steer patients to lower cost providers without consideration of quality. How does radiology move then from the perception of being a “passive” specialty in regard to patients, potentially treated as a low-cost commodity and therefore, able to maintain some level of control over its destiny?

Alan C.Kay stated, “The best way to predict the future is to create it.” What can this look like for radiology?

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An Interview with Imagine CEO, Sam Khashman

Imagine’s fearless leader and CEO, Sam Khashman, sat down with the team at the RBMA Bulletin to talk about taking business risks, data security, and the changing trend in practice collections. Take a look at what he had to say in the RBMA May-June Bulletin Thought Leader spotlight:

When you founded the company, did you have a sense of what it would grow into and that you would still be running it today?
Thinking back to the beginning, our vision, endless ideas and drive would have had us bigger and more successful in our own minds. I think we always thought of super success without an end in sight. We probably didn’t quite think about all the mountains we would have to climb and the hurdles that we would have to overcome; and that endless ideas and drive command an equal amount of resources. I am certain that every entrepreneur firmly believes in their success and the immortality of their idea, their company and their team. In our case, we set nonnegotiable goals. Success and servant leadership are on top, and we are grateful that they have been well received for 15 years.

How important has taking risks and innovating been to your company’s overall success?
I believe that taking more risks than anyone else thinks is practical and surrounding yourself with a very creative team that can execute is key to any company’s success. The French romantic Victor Hugo wrote, “nothing is as powerful as an idea whose time has come.” In modern times we might add “…and a strong team and likeminded partners that can execute and maintain relationships.” Additionally, we believe that servant leadership and continuous innovation of systems, processes and products play a vital role.

Data security is becoming a big challenge for healthcare. Have you seen the need for security go up since ImagineSoftware was launched?
The healthcare IT landscape has changed significantly and the need for security has dramatically increased since we first began our journey. Cybersecurity was a Star Trek, insider, geek term in 2000. Today cyber-attack, -breach, -security are on the minds of most Americans and front and center for any business with sensitive data. Particularly scary breaches are the ones that involve PHI and surrounding information because these constitute the most severe breach of privacy. It seems that not a week goes by without news breaking of a healthcare system, practice or cloud provider being breached. Unfortunately, most breaches are successful on the attacker’s end and a failure on the side of the folks charged with safeguarding the data. The short version is that if an individual actor, an organization or even a foreign government spends enough time and resources, they will likely be able to get in.

Our company has implemented multilevel systems to include intrusion prevention and intrusion detection at the n-point in addition to putting in place the proper protocols for stop-of service and risk mitigation. We have added an entire department of high powered cyber folks headed up by our chief strategy officer, a veteran in the cyber field who has implemented mission-critical systems for national interests. These folks are available to our clients and assist in critical infrastructure design well beyond the Imagine system. Finally, we have built our own data center to ensure that we provide clients who like the convenience that cloud-based systems bring but don’t want to take a gamble on a third party with a viable alternative.

What do you anticipate will happen to practice collections and how will Imagine play a role?
The recent reimbursement cuts and the combination of procedures that hit radiologists’ pocket books may have been just a preview to what the mounting patient responsibility component will become. The theory was that true self-pay would disappear, but the reality is that the dollar volume simply shifted from one bucket to the next. Deductible, self-pay after insurance, enrollment periods, etc. impact collections more now than ever before. In anticipation of this shift, we helped create a number of patient payment solutions that assist our clients in the collection effort while maintaining a healthy and positive relationship with the patients. Imagine makes these options and systems available to its clients without the need or cost of additional software licensing. Our clients have had great success in not just the mitigation but also the increase of income on this journey.



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