A Plethora of Policies in the Pittsburgh Market and Beyond

And the challenges and opportunities created by their abundance


The passing of The Affordable Care Act created many changes for the insurance markets and providers across the United States.  Main Street Medical is helping private practices and hospital managed practices navigate these changes.  Here in our home state of Pennsylvania, as in many other markets, new insurance products were created to offer consumers affordable options in healthcare and making it easier to comply with the health insurance mandate.


While the mandate was a new precedent in and of itself, the insurance products created as a result were also new territory for many healthcare practices. Both private practices and hospital managed practices across the country, are finding themselves navigating the complex landscape created by the myriad insurance companies, making changes to existing plans and offering new ones tailored to their customers. Amplify this across all of the options available to patients in our area, and it gets quite complex.


While the abundance of changes to existing plans and the plethora of new plans in the marketplace creates some challenges, there are also opportunities.  Main Street Medical can help you adjust and mitigate many of these challenges, while also preparing your practice to reap the benefits of this new health insurance landscape, whether you’re located here in Pittsburgh, or anywhere across the country.  Our experts are ready and able to pinpoint the nuances of your local insurance market.


How to Stay in Front of the Changing Healthcare Options

It’s almost impossible to expect your front office staff to understand the nuances of the many different plans offered by the area’s insurance companies.  While some articles and blogs might suggest staying on top of these changing and evolving products, Main Street Medical offers you the tools needed to simplify the billing process.  


Practice Insight is a nationally known electronic clearinghouse, providing tools for claims submission and payment retrieval, but also incorporating patient eligibility and patient cost estimation tools.  With tools like Practice Insight available through Main Street Medical, you can have the tool automatically check the night before to make sure the patients you are seeing the next day have valid health insurance, and whether you are able to work within their current plan selections.  


Additionally, Main Street Medical clients have access to the Patient Cost Estimation (PCE) tool, which allows providers to input the services to be rendered, and receive an accurate estimation of the patient’s financial responsibility after insurance of those services.  This provides clear documentation for the patient and the provider simultaneously and negates any surprises on either party’s part.  Managing expectations and mitigating surprises during the billing process creates a smooth exchange and helps to encourage patients to schedule follow up and regular wellness visits.


Taking it a step further, Practice Insight offers a claims scrubber, that reviews the different pieces of your claim before it’s submitted, to make sure all of the necessary information is there and ensure your claims are processed successfully and on time.


To learn more about these tools or to speak to an expert, please give us a call at (412) 428-7700.