Navigating Regulatory Waves for Healthcare: How Upcoming Changes Will Shape Payments

This article is the first in a series exploring the topic of trends in healthcare. Alongside our partners at Zeal, we will discuss healthcare and payment trends and the implications they have on HealthTech. Our goal is to bring attention to these trends so that those of us building tech for healthcare can be better equipped to handle what is to come. Read Zeal's first article here.

In our first article of our series, we break down the recent regulatory shifts, their impacts, and how to navigate this evolving landscape.

Recent Changes In Healthcare

Rising Out-of-Pocket Expenses

New regulations are set to increase out-of-pocket healthcare costs, making flexible payment solutions more important than ever:

• Individual Coverage 2025: Minimum deductible increases by $50 to $1,650; out-of-pocket maximum rises by $250 to $8,300.
• Family Coverage 2025: Minimum deductible increases by $100 to $3,300; out-of-pocket maximum rises by $500 to $16,600.

These changes mean patients will have higher costs. The payment industry must be ready to add more flexible and adaptable payment options to ease this trend.

Boosting Telehealth and Digital Health Services

Several regulatory changes are paving the way for telehealth and digital health services to be more accessible.

• New Billing Codes: CMS introduces new digital mental health treatment device codes to ensure proper reimbursement.
• Audio-Only Telehealth: Continued payments for audio-only services, especially in rural areas.
• Waived In-Person Requirements: Easier access to telemental health services.
• Telehealth Flexibility: Expanded use of telehealth in opioid treatment programs.

Improving Transparency and Patient Protection

Transparency and patient protection notorious issues in the healthcare space. Now, new regulations are being implemented to illuminate hidden costs and protect patients.

• Price Transparency Law: Hospitals and insurers must publish their rates, making it easier for patients to shop around.
• No Surprises Act: Limits unexpected out-of-network charges, protecting patients from surprise medical bills.

Impacts on Healthcare Providers, HealthTech, and Patients

Financial Stress on Patients

Medical debt is a leading cause of bankruptcy and financial stress among Americans. Providers must offer flexible payment plans and financial assistance to help patients manage these costs.

Adopting Digital Health Technologies

The government is prioritizing access to advanced healthcare technology. With Congress approving over $42 billion to expand access, payment platforms need to step up. Providers need to be able to manage billing and reimbursement so that patients can benefit without additional hurdles.

Expanding Telehealth Services

With demand for telehealth skyrocketing providers must be able to accept all forms of payment to be able to serve more people. The U.S. digital health market is on a rapid ascent, expected to hit $50.17 billion in 2024 and grow at a compound annual rate of 7.48% from 2024 to 2028. The growth highlights the pressing need to support telehealth capabilities to effectively cater to increasing patient demands.

How Pay Theory Helps

Flexible Payment Solutions

Pay Theory is the only payment company built to serve and grow with the emerging health tech industry:

• Payment Plans and BNPL Options: Allow patients to spread out their healthcare costs, making it easier to manage expenses. Learn more here.
• Remote Cash Acceptance: Enables patients to make payments conveniently, even if they lack traditional banking services. Learn more here.

Integration with Digital Health Technology

Pay Theory is built to handle the complexities of the rapid growth of the digital health industry:

• Seamless Integration: Supports new billing codes and ensures HIPPA-compliant payment processing for all digital health SaaS platforms.
• Enhanced Telehealth Capabilities: Facilitates smooth transactions for telehealth services, ensuring patients get the care they need.

Improving Price Transparency

Pay Theory helps providers comply with all new transparency regulations by:

• Clear Billing Methods: Developing ways to publish contracted rates clearly and accessibly.
• Tracking Regulation: Pay Theory religiously tracks the health tech space to ensure compliance with all current and future regulations.

The healthcare and technology industries are joining forces, driving significant regulatory changes. By understanding and preparing for these changes, healthcare providers and payment platforms can turn regulatory challenges into opportunities for growth and innovation. Pay Theory is pioneering fintech for must pay industries—helping healthtech platforms succeed in improving accessibility in healthcare.

Visit our healthcare page or contact our sales team to learn more about payments in the healthcare space.