Collecting More Accurately
with Consumer Choice Plans

As consumer choice plans become more prevalent, physician offices are seeing patients with various types of payment accounts, such as Flexible Spending Accounts (FSAs), Personal Care Accounts (PCAs) and Health Savings Accounts (HSAs).While patients may appreciate the greater flexibility and tax advantages with these new consumer choice plan designs, medical practices are struggling with identifying the patient’s payment responsibility at the time of service. This process is important for account holders due to Internal Revenue Service (IRS) requirements for substantiation of transactions within these accounts.

The chart below offers an overview of account types.

The HumanaAccess^sm Visa^® debit card allows members to access funds in their PCA, FSA or HSA. Humana encourages physician offices to follow these processes to appropriately charge the patient’s medical expenses and to avoid having to reconcile the amount charged to the patient with the allowable.

• Swipe the patient’s card at the time of visit for copayments only, using the “credit” key. If your practice’s policy is to swipe the card for coinsurance and deductibles as well, the patient will need to keep the receipt for later reconciliation with Humana. Keep in mind that this may mean your office will owe the patient a credit, or that the patient’s card will have to be billed again for any additional amount owed.
• After Humana has processed the claim and your practice has received a remit notice from Humana stating the amount owed by the patient, you can use the patient’s HumanaAccess card to obtain payment. Key in the patient’s account number and expiration date to automatically charge the amount owed (with prior approval from the patient).

To improve this process in the future, Humana is working to make real-time claims adjudication a reality (RTCA) (please see Making Real-Time Claims Adjudication a Reality on page 2), which would allow online access to the patient’s deductible and the exact amount to charge to his or her HumanaAccess card at the time of the visit.

Types of Accounts      Personal Care Account (PCA)    Health Savings Account (HSA) A set dollar amount is deposited into the account by the employer. Funds can be used toward the deductible and to pay for eligible expenses as defined by the employer. PCA funds can be used for: • Out-of-pocket prescription costs associated with the health plan • Eligible medical expenses, such as doctor’s office visits, X-rays and laboratory tests • Some services that are not covered by the health plan, but may be eligible for reimbursement under IRS guidelines Unused funds can be carried over to the following year. The IRS refers to this type of account as a Health Reimbursement Arrangement (HRA). Claims are substantiated, meaning that the health plan must substantiate that the funds were used for qualified medical, vision or dental expenses.   A tax-free savings account that both the employee and employer can contribute to for current and future medical expenses. All amounts contributed toward an HSA belong to the account holders (employee) and may be invested similar to the way a 401K or IRA may be invested. Any unused HSA funds roll over to the next plan year. The HSA is also portable; employees can take it with them when they leave their employer. Contributions to HSAs have a ceiling, based on several variables. Contributions to an HSA over the IRS-set limits are taxable and subject to penalties. Claims reimbursements and expenses are not substantiated by the carrier or the HSA bank vendor. The account holder is responsible for ascertaining whether the expenses are eligible under federal guidelines.  Flexible Spending Account (FSA) Similar to the PCA, except that funds are contributed by the employee and/or the employer; unused funds are forfeited to the employer at the end of the year. Claims are substantiated, meaning that the health plan must substantiate that the funds were used for qualified medical, vision or dental expenses.