The Higher the Patient Debt, the Harder it is to Collect​

From Athena Insight:

It’s well known that high-deductible health plans affect not only patients, but also the medical practices that care for them. As individuals take on more financial responsibility for their healthcare, patient obligations have gone up accordingly and now account for 18 percent of provider revenue.

Also clear from practice data (and perhaps of no surprise): Collecting larger amounts from patients is typically a lot harder than collecting smaller obligations. One athenahealth network study, for example, found that practices collect about 40 percent of patient balances at the time of service when patients owe less than $35, but just 6 percent of what they’re owed when the patient’s balance is over $200.

Given that at most practices high-balance claims are relatively rare, does it make sense to invest limited resources in ensuring those claims are eventually paid?

The answer is yes, according to new data from researchers.

An analysis of more than 44 million commercial claims billed in 2016 by about 6,400 providers on the athenahealth network confirmed that only a small fraction of the claims were “high balance” – $200 or more. However, the data also show that high-balance claims comprise 25 percent of commercial patient obligations overall, and 45 percent of all obligations that remained uncollected after five months.

For more information on the issues surrounding medical debt, please contact RIP Medical Debt.