What Value-Based Care Means for Medical Billers and Coders

By Karen Smiley

The current trend in commercial healthcare is called value-based care (VBC), where the patient bears a greater share of cost. Fewer plans use office copays, and more plans apply the office visit obligation to the patient’s deductible. The problem with this approach is that patients aren’t quite as efficient at making payments as the insurance company is.

First of all, in many instances, the provider doesn’t know what amount the contract is going to allow for the service provided, which makes asking the patient to pay upfront a little tough. In addition, many of these plans come with an FSA (Flexible Spending Account), an HSA (Health Spending Account or Health Savings Account), or even an HRA (Health Reimbursement Account). Some patients may be skeptical paying with one of these cards when they have no guarantee that the payment is correct.

Each of these plans has very strict usage guidelines, and only certain types of services or commodities are payable from these funds. If a patient overpays, the fund must be reimbursed, and that can be a nuisance for both the provider and the patient.

From a cash flow standpoint, these plans can be a problem. Various approaches are being tested; some offices ask for a flat down payment amount and bill the patient for the balance. Billing patients can be expensive, though, and vigilance of patient accounts becomes a much higher priority than in years past. For some time, many offices would carry a patient account for several months (especially if the patient was long standing or a “frequent flyer”), but with a VBC model, those policies will need to be revamped, and a more aggressive collection approach will likely be necessary.