Checklist: Proactive OBBBA planning

Like many things in healthcare policy these days, much remains up in the air about how the recently enacted One Big Beautiful Bill Act will play out in terms of its effect on your healthcare organization’s balance sheet. So far, the estimates aren’t promising: The bill is expected to reduce budgeted federal healthcare spending by more than $1 trillion by 2024. How much of that money will come from healthcare provider organizations’ balance sheets remains to be seen. 

What we do know now is that the nation’s uninsured population is no doubt going to rise. And, the Medicaid patients our healthcare organizations serve today might not be eligible for Medicaid in the not-too-distant future. 

Many of the bill’s provisions are set to roll out in the coming months, making it a good time to get your house in order to prepare for what’s ahead. To help, Kodiak created a checklist of to-do list items for consideration now. 

Checklist: Proactive planning for the OBBBA 

Take a fresh look at your financial assistance policy.

There’s looking at your financial assistance policy, which many organizations do annually, and there’s really looking at your financial assistance policy, meaning taking a deep dive into your data to better understand where your noncovered services are occurring. 

Now is an ideal time to look at your numbers. Do you know how many of your patients qualify for your Federal Poverty Level percentages or are Medicaid patients? Do you know how many of your Medicaid patients are written off to bad debt who might qualify for charity care now or in the future? Knowing your uncompensated care numbers is always vital to your finance and reimbursement performance. With today’s regulatory upheaval, it’s even more so. 

• Spend time reviewing your organization’s uncompensated care numbers. 
• Make applicable changes to your financial assistance policy language to make sure you’re capturing patient statuses correctly. 

Reevaluate your presumptive charity screening processes. 

For those organizations that use presumptive eligibility screenings for charity care, it’s a good time to reexamine any tools you use, vendors with whom you contract, and your screening processes for determining charity eligibility. In general, the sooner you’re able to make the determination about a patient’s eligibility for charity care, the better. 

• Determine when you are screening presumptive charity care patients. 
• Evaluate this timing and consider its role within your overall revenue cycle process. 
• Consider questions like: 
• Are you screening patients earlier on in the process? 
• Are you waiting until the patient is written off to bad debt to screen them? 

Review your uninsured discounts. 

With the understanding that your organization likely will have an influx of uninsured patients coming through your doors, it’s wise to review your self-pay discount policies. 

• Review your current uninsured discount policy and how you set your discount rates. 
• Make necessary adjustments that capture and account for what most likely will be a large increase in uninsured patients. 

Adjust DSH eligibility screenings. 

Many provider organizations go through an annual process—typically at the end of their fiscal year—to calculate the percentage of their low-income and Medicaid patients who are eligible for supplemental payments. With the OBBBA’s changes to Medicaid eligibility, there likely will be fewer numbers of patients who qualify for DSH eligibility and fewer hospitals qualifying as DSH hospitals. 

• Review the frequency with which your organization reviews DSH eligibility. 
• Consider screening for DSH eligibility every six months versus annually to account for patients who no longer are eligible for Medicaid due to the OBBBA provisions. 

Prepare for an increase in ED cases. 

As more patients become uninsured and lack access to primary care due to the OBBBA’s provisions, a strain on emergency departments will be evident. Consider taking steps now to bolster care coordination and drive more patient awareness about when patients should use the ED and when they should seek care in outpatient settings. 

• Develop community awareness and education campaigns about your organization’s outpatient services and when to seek care there versus in the ED. 
• Consider ways to increase access to outpatient clinics, including offering expanded hours. 
• Lean on telehealth and consider additional areas where it might be able to help fill care gaps. 

How can we help? 

If one thing’s certain in healthcare now, it’s that nothing is certain. What you can rely on now and anytime is for Kodiak to keep you up to date with the information you need and the solutions and data that can help you navigate regulatory and market changes, including cascading effects from the OBBBA.

As more information about the bill becomes known, we are here to help you make moves to mitigate any impacts and shore up your finance and reimbursement defenses. Contact us anytime. We’re here for you.