Healthcare Providers Turn to California Software Company to Overcome Challenges Presented by New Association Health Plans

2018-08-07 20:19:42

In September of this year, small businesses and self-employed individuals will be allowed to purchase a new type of low-cost health insurance through trade groups and industry associations. Theseassociation health plans will allow employers to bypass expensive traditional small-group and individual insurance markets when obtaining coverage for themselves and their employees.

But they come with an important caveat: the cost savings is due primarily to a recentexecutive action exempting AHPs from a wide range of consumer protections like offering Affordable Care Act-mandated essential health benefits. By some estimates, there are 11 million small business owners in the United States who could purchase AHPs, and 4.3 million individuals are expected to ultimately be covered by these discount health insurance plans.  

Expect Uncertainty and Disruptions

While these plans may wind up offering small business owners and their employees more affordable insurance options, for health systems, hospitals, and physician groups, this new type of insurance means wading into the unknown and managing an even larger volume of payer contracts.

Starting September 1, hospitals and ASCs will brace for anincreased volume of AHP-covered patients, but they are uncertain of how to staff or budget for the expected census increase. Most providers already are managing a large volume of fee-for-service and value-based contracts, each of which includes multiple plans with different rates. AHPs, which also will be allowed to be sold across state lines, will add a new type of reimbursement model to providers’ revenue cycles.

Traditional payers are barred from setting up AHPs directly, so a flood of untested payers – perhaps all with different reimbursement rates and terms – could enter individual markets, depending on the local consumer demand. Still, theAmerican Academy of Actuaries predicts that some AHPs may end up “renting” network access from existing HMOs, adding yet another potentially complex wrinkle to the fast-changing payer landscape,   

Finding Clarity

Revenue Masters is a Southern California-based technology company that helps hospitals and physician groups eliminate the financial uncertainty associated with seeking reimbursement from AHPs. By offering cloud-based software thatmodels and manages any contract from any payer, providers can eliminate claims underpayments and denials across multiple facilities, payers, and plans. It also enables facilities to drill down to the individual physician and service level and model an expected reimbursement to the claim level, based on multiple calculations. Revenue Masters technology gives providers peace of mind by generating projected snapshots of expected net revenue within the next 30, 45 and 60 days. A mobile app is also available for tracking reimbursements while on-the-go.

Interested in learning more about how Revenue Masters technology can help providers simplify managing contracts with Associated Health Plans? Call today at (877) 591-2590 or email at sales@revenuemasters.com to book an introductory call with one of their senior reimbursement experts. Revenue Masters is dedicated to combining cloud contract modeling and management with fast and efficient payment recovery workflows to create the most advanced platform that enables 100 percent collections across all payers.

Their team has decades of experience in managed care, as well as commercial and government payer strategies, providing their partners with unique insights into healthcare market dynamics.

Revenue Masters also helps facilities improve efficiency and workflows. They offer the most modern, powerful, accurate and affordable healthcare contract management software, all while being the undisputed price performance leader – providing the best value for the best price. Revenue Masters software increases efficiency and revenues, provides all necessary reports and can help you ensure 100 percent payer collections.