Direct Access to Dynamic, Independent Private Practices in the Best Locations

EMrecruits Blog

The Impact of High Deductibles on the Emergency Department

Posted by Justin Schaper, SVP of Client Information Services

9/25/14 8:30 AM

The Impact of High Deductibles on the Emergency Department

Author:  Justin Schaper, SVP of Client Information Services
Data Provided By:  Brett Wachter, Practice Administrator 
 

Reimbursement Denials Increase

With the increase of high deductible plans in the market this year, drops in reimbursement have naturally been anticipated.  Claim processing and resulting collections for 2014 are now mature enough to begin to quantify the impact.
Figure 1, below, demonstrates the actual insurance reimbursement denials for a large, seven facility, emergency physician group in a metro / suburban area of the south eastern United States.  The data points are calculated by taking the dollar adjustment amount attributed to patient deductibles as identified in the insurance EOB statements.  A normalized metric is created by dividing by the January 2012 dollar amount to show variation on a percent basis.  January of 2012, 2013, and 2014 are marked with arrows for easy reference.

impact-of-high-deductibles-on-the-emergency-departmentFigure 1: Insurance Reimbursement Adjustments Due to Deductible


As is shown, the January 2014 deductible driven denials on a dollar basis increased by 64% over January 2013, and by 142% over January 2012.  February and March were also well elevated over prior years, leading to a severe impact for the first quarter as a whole.  On the a positive note, April amounts are back down to levels consistent with 2013.  May and June are not entirely mature data sets, but are anticipated to be more in line with 2013.

Interested in more stories related to Emergency Medicine Practice Management?  Check out the EMrecruits Blog for our post on Optimizing Emergency Department Scheduling in Real Time

Looking for a Job?  Get Started with EMrecruits!


 

Topics: Industry Topics