Collector – July 2019 - 46

BUSINESSOPERATIONS

"Not everyone has
great, affordable health
insurance or secondary
insurance to help offset
high, unexpected, outof-network charges."

"After the law went into effect, the
providers were not aware or well educated
on the requirements under the new law and
were not certain of its impact on balance
billing," she said. "I think initially we had
a lot of providers that strictly focused on
making sure they weren't violating the law
without necessarily understanding the law
and its application."
Despite these challenges, legislation to
rein in balance billing and its impact on
consumers will continue.
Reynaud recommends providers and their
collection agency business associates work
together to stay informed on legislative and
compliance issues through state and national
medical associations, such as the California
Medical Association and Medical Group
Management Association.
"In California, or in any state that has
current laws on balance billing or laws
on the horizon, the most important thing
that a provider can do is make sure they
have policies and procedures in place
documenting how they handle balance
billing for non-emergency or emergency
services with patients that have insurance
being denied for out-of-network charges,"
Reynaud said.

BALANCING COMPLIANCE
California's legislation is different from
laws in other states and proposed bills at the

46

federal level in that it doesn't cover charges
as a result of a patient's emergency services.
In Florida, for example, legislation dating
back to July 2016 protects patients from outof-network charges at an in-network facility
in emergency situations.
Before the legislation took effect,
Matt Kiefer, chief officer of information,
compliance and development at The
Preferred Group of Tampa in Tampa,
Florida, said his agency received medical
accounts from unexpected charges due to
balance billing.
"Covered charges and noncovered charges,
coupled with high deductibles and copays, can
not only be confusing but upsetting, and only
exacerbates the issue when out-of-network
charges and balance billing is allowed," Kiefer
said. "Legislation like H.B. 221 in Florida to
prevent surprise charges helps the patient in
an already uncomfortable position. Let's face
it, John and Jane Doe didn't plan to get in a
major car accident that Friday night when
the grandparents were watching their kids.
They didn't plan on $100,000 in medical
bills. It is not like racking up debt on a credit
card because you wanted a high-definition
television to watch the Super Bowl. Not
everyone has great, affordable health insurance
or secondary insurance to help offset high,
unexpected, out-of-network charges."
When it comes to federal legislation,
Congress appears to be focused on
preventing charges from out-of-network
emergency care for consumers. Some
hospitals and medical associations
advocating for the legislation want patients
removed from the debate on these charges
altogether.
State laws and discussions on pending
legislation also present arbitration options
for consumers who receive balance billing
charges or flat fees for care that could create
these charges.
As these legislative discussions continue,
Reynaud stresses the importance of
education for collection agencies, health care
providers and consumers.
If there is pending legislation in your
state, Reynaud suggests hosting a webinar
for clients or coordinating office training for

your provider client's staff about situations in
your state that may present a violation under
a balance billing law and to discuss policies
and procedures for working with consumers.
"If providers are more compliant and the
information I receive on an account is better
when it does come to collections, then I can
be more confident that we are not at risk,"
Reynaud said.
This education also helps agencies that
regularly work with patients to explain their
medical bills and charges.
"The patient always thinks they have
insurance coverage at 100 percent,"
Reynaud said. "Explaining to the patient
why they owe a balance is at the core of
what we do each day. After we can explain
what they owe and why they owe it, we are
able to ask for payment in full or set up a
payment arrangement."
If payment arrangements can't be made,
Reynaud's company can provide the patient
with additional resources on who they
can contact for help if they need more
information about insurance coverage,
such as their employer's human resources
department or by calling the insurance
company directly.
Agencies and their health care provider
clients need to understand existing laws
-and bills that might become laws-that
could affect their operations. For example,
Keifer noted that providers should
ensure their billing software systems are
programmed not to balance bill if it's
not allowed for certain medical account
types. A provider's billing team also needs
to know how to flag accounts that may
otherwise slip through the cracks.
"The bottom line is to continue to train
collectors to be empathetic when working
with consumers with medical debt, especially
when it comes to medical debt from surprise
medical bills if there is not legislation in
your state and the charges are from out-ofnetwork providers," Kiefer said.
Katy Zillmer is ACA International's
communications specialist.

ACAINTERNATIONAL.ORG


http://www.ACAINTERNATIONAL.ORG

Collector – July 2019

Table of Contents for the Digital Edition of Collector – July 2019

Upfront
Industry News
Best Practices
FYI
Collection Tips
What you need to know about the CFPB’s proposed new rule for the debt collection industry
“I don’t know about you, but I’ve literally never received a telegram and wouldn’t even know how to send one.”
Celebrating 80 Years of Helping Members Succeed
How Does ACA Help Members Succeed?
A History of Advocacy
8 Decades of ACA’s Annual Convention
Calendar
Honor Roll
Education Spotlight
Tell It Like It Is: Washington Hears From ACA Members
Collectors Challenge 2019: Getting Creative for a Good Cause
Balance it Out
Balance Billing Challenges Continue
It’s All About You: Helping Members Succeed
Sandbox Rules
What is a Product Sandbox?
in 11th Circuit Case Examining What Constitutes an ATDS
ACA SearchPoint
Ad Index
Membership
Last Word
Collector – July 2019 - Cover1
Collector – July 2019 - Cover2
Collector – July 2019 - 1
Collector – July 2019 - 2
Collector – July 2019 - 3
Collector – July 2019 - Upfront
Collector – July 2019 - 5
Collector – July 2019 - Industry News
Collector – July 2019 - 7
Collector – July 2019 - 8
Collector – July 2019 - 9
Collector – July 2019 - Best Practices
Collector – July 2019 - 11
Collector – July 2019 - FYI
Collector – July 2019 - 13
Collector – July 2019 - Collection Tips
Collector – July 2019 - 15
Collector – July 2019 - What you need to know about the CFPB’s proposed new rule for the debt collection industry
Collector – July 2019 - 17
Collector – July 2019 - “I don’t know about you, but I’ve literally never received a telegram and wouldn’t even know how to send one.”
Collector – July 2019 - 19
Collector – July 2019 - 20
Collector – July 2019 - 21
Collector – July 2019 - 22
Collector – July 2019 - 23
Collector – July 2019 - Celebrating 80 Years of Helping Members Succeed
Collector – July 2019 - 25
Collector – July 2019 - How Does ACA Help Members Succeed?
Collector – July 2019 - 27
Collector – July 2019 - 28
Collector – July 2019 - 29
Collector – July 2019 - A History of Advocacy
Collector – July 2019 - 31
Collector – July 2019 - 8 Decades of ACA’s Annual Convention
Collector – July 2019 - 33
Collector – July 2019 - 34
Collector – July 2019 - 35
Collector – July 2019 - Calendar
Collector – July 2019 - Honor Roll
Collector – July 2019 - Education Spotlight
Collector – July 2019 - 39
Collector – July 2019 - Tell It Like It Is: Washington Hears From ACA Members
Collector – July 2019 - 41
Collector – July 2019 - Collectors Challenge 2019: Getting Creative for a Good Cause
Collector – July 2019 - 43
Collector – July 2019 - Balance Billing Challenges Continue
Collector – July 2019 - 45
Collector – July 2019 - 46
Collector – July 2019 - 47
Collector – July 2019 - It’s All About You: Helping Members Succeed
Collector – July 2019 - 49
Collector – July 2019 - 50
Collector – July 2019 - 51
Collector – July 2019 - What is a Product Sandbox?
Collector – July 2019 - 53
Collector – July 2019 - in 11th Circuit Case Examining What Constitutes an ATDS
Collector – July 2019 - 55
Collector – July 2019 - ACA SearchPoint
Collector – July 2019 - Ad Index
Collector – July 2019 - Membership
Collector – July 2019 - 59
Collector – July 2019 - Last Word
Collector – July 2019 - Cover3
Collector – July 2019 - Cover4
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