The healthcare system in the United States is always changing. A new law in New York State will take effect on October 20, 2024. It will change how hospitals handle their financial assistance programs and debt collection practices. The purpose of these changes is to support patients better, especially those who are underinsured, while ensuring fairness in medical billing. This guide will help hospital administrators, owners, and IT managers understand the new requirements and take the necessary actions.
Overview of Legislative Changes
The new law introduces several important modifications to current regulations regarding hospital financial assistance and debt collection:
- Expanded Financial Assistance Eligibility: The definition of “underinsured” has changed. An individual is now underinsured if their out-of-pocket medical expenses exceed 10% of their gross income in the past 12 months. Hospitals must expand their financial assistance programs to help more patients who find it hard to pay for medical care.
- Income Thresholds for Waivers and Sliding Scale Charges: Starting from the effective date, hospitals must waive all charges for individuals earning below 200% of the federal poverty level. For those earning between 200% and 400% of the federal poverty level, a sliding scale fee system must be used, limiting charges to certain amounts or a set percentage of typical Medicaid payments.
- Restrictions on Debt Collection Practices: New rules stop hospitals from denying treatment due to unpaid bills. They cannot sell medical debts to third-party collectors either. Furthermore, hospitals cannot initiate legal actions against patients earning below 400% of the federal poverty level for at least 180 days after the first bill is issued. This gives patients time to apply for financial assistance without pressure from collectors.
- Clear Communication and Notification Requirements: Hospitals must inform patients in writing about financial assistance options as part of the discharge process. This change ensures patients know their options before leaving the hospital.
- Patient Consent Regulations: Patients should receive separate information about treatment and payment terms. Hospitals cannot require consent for payment before discussing costs. This ensures that patients understand their financial obligations after care.
- Credit Card Payment Risks: New rules require hospitals to inform patients about the risks of using credit cards for medical payments. Such risks can include losing certain protections for medical debt, making patient education important.
- Reporting Requirements: Hospitals in the State Indigent Care Pool must regularly report to the New York State Department of Health on the number of individuals applying for financial assistance and their approval or denial status. This aims to maintain accountability and transparency in the financial assistance process.
Adapting to the Changes: Steps for Compliance
To meet these new regulations, hospitals need to thoroughly review their existing financial assistance and debt collection practices. Here are some steps administrators can take:
- Policy Review: Form a team to evaluate current financial assistance programs and debt collection practices. The goal should be to align policies with the new rules, focusing on patient eligibility and notification processes.
- Training Staff: Ensure all employees involved in patient intake, billing, and collections understand the legislative changes. Training must cover new definitions, processes, and patient rights.
- Implementing Communication Strategies: Create effective communication strategies that prioritize informing patients about financial assistance. Written notifications must be clear, delivered during discharge, as required.
- Revamping Consent Processes: Develop separate consent forms for treatment and payment. This change is important for compliance and should include a section that informs patients of credit card payment risks related to their medical services.
- Monitoring Debt Collection Practices: Review current debt collection policies to ensure they comply with the new restrictions. Establish guidelines to prevent legal actions against vulnerable patients and to handle accounts flagged for financial assistance eligibility.
- Reporting Mechanisms: Set up reliable systems to document and report financial assistance data to the state health department. This includes tracking the number of financial assistance applicants, their outcomes, and strategies for reaching eligible individuals.
The Role of Technology in Compliance: Enhancing Operations with AI
Understanding the upcoming changes in financial assistance and debt collection allows hospitals to use technology effectively, especially AI and workflow automation, to help with compliance and improve operational efficiency.
Innovating Debt Collection Through AI
AI technologies can change how hospitals manage communication and processes related to financial assistance and debt collection. They can automate repetitive tasks and create efficient workflows.
- Streamlined Communication: AI systems can automatically inform patients about financial assistance during discharge through follow-up calls or texts. This helps to comply with regulations while protecting patient data. AI can be programmed to send personalized messages, ensuring patients receive information relevant to their financial situations.
- Automating Patient Intake: AI can simplify the patient intake process by collecting and processing financial information using digital forms. This allows hospitals to quickly and accurately assess financial assistance eligibility.
- Data Analysis for Better Decision-Making: AI can analyze historical patient data to identify trends regarding financial assistance requests. This understanding helps administrators tailor outreach efforts and improve service delivery.
- Simplifying Reporting: AI tools can streamline the reporting processes for state-required documentation. Instead of relying on manual tasks, AI can aggregate necessary data, ensuring accurate submissions to the New York State Department of Health.
- Tracking Financial Assistance Applications: AI can monitor trends in patient applications and approvals, revealing gaps in outreach. This helps hospitals adjust their financial assistance strategies to address changes in the healthcare environment. AI can also aid in tracking patient follow-ups to improve how applications are processed.
Continuous Evaluation of Practices
Beyond merely complying with new laws, hospitals in New York should commit to regularly evaluating their financial assistance policies and debt collection practices. This ongoing improvement should involve:
- Patient Feedback Mechanisms: Find ways to gather feedback from patients about their experiences with financial assistance programs and billing. This feedback will help inform adjustments to services and policies.
- Regular Training Updates: As laws and regulations change, hospitals should provide frequent training updates for staff to keep them informed about current practices and patient rights.
- Assessing Technology Needs: Periodically review how well the technologies being used serve their purpose. Hospitals must ensure that their AI and automation tools meet service demands and support compliance efforts.
- Policy Reevaluation: Regularly revisit policies regarding financial assistance and debt collection to ensure alignment with legislative updates and best practices.
By focusing on these new requirements and utilizing technology advancements, hospital administrators can meet compliance goals while also promoting a supportive healthcare environment. These strategies will not only fulfill legal obligations but will also ensure that every patient receives the attention and assistance they need. The changes in legislation reflect a significant movement toward fairer healthcare access, highlighting the need for adaptability and proactive engagement in medical billing practices.
