How the ACA (Obamacare) is Changing How Practices Do Business
Mary Pat Whaley, FACMPE, CPC
Medical Practice Consultant, Manage My Practice LLC
Practices: Confusion About New Plans
There is a lot of confusion over the exchange plans. Some practices are not clear which payers have offered exchange plans in their states and whether the practice is taking the plan by default due to an "all products" clause in a current contract or by a separate decision that the practice has made to take the plan based on reimbursement. This confusion is leading, in general, to practices giving much more time and attention to current contracts and new contracts and to training or retraining staff as to what plans the practice takes, what the cards look like, etc. Practices have to spend more resources on understanding and managing the ACA plans.
Patients: Confusion About New Plans
Patients who have not had insurance before, or who have not had high-deductible plans before, may not realize they are responsible for first-dollar payment for care until their deductible is met. Many patients think their deductible has to do with hospital care only, and when they find out that their office visit requires a payment beyond a co-pay, they may defer medical care. Payers and physicians both need to assist in educating patients about establishing with a primary care physician, as we have seen patients with insurance are sometimes still seeking care at the Emergency Room, which is what they know. Patients may not seek the care they need at the right time at the right level of service.
The 90-Day Grace Period
Patients with exchange plans can actually use the plan for 90 days without paying any premium - this is the grace period. Payers are required to pay their portion of the claims for any services during the first 30 days, but are not required to pay any claims submitted during the remaining 60 days until the premium has been paid by the patient. If the patient declines to pay the premiums, insurance plans will recoup anything they have paid the practice during the first 30 days and practices will be left to collect in full for the services from the patient. Practices are at risk financially for the cost of any services provided to patients with exchange plans during the first 90 days of the plan.
How Can Practices Deal With the Changes?
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Review all current payer contracts and make sure you know what you are being paid by each plan. Are you being paid the same by exchange plans as you are for non-exchange plans offered by the same payer?
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Don't have more than 30% of your business with any one payer if you possibly can. Don't put all your eggs in one basket.
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Put time and resources into revenue cycle management on both insurance receivables and patient receivables as both are critically important to survival.
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Purchase technology to estimate patient balances so you do not have to collect from patients on the back end, and you can help patients understand in advance what their financial responsibility is.
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Convert to a Credit Card on File (CCOF) program, where the practice has the ability to control the timing of the payment of patient-responsible balances, and can protect themselves financially.
Mary Pat and Abraham Whaley are presenting a free 30-minute overview of Credit Card on File on Thursday, April 17th. More information here: https://student.gototraining.com/r/274486838462512384
Photo Credit: davidyuweb via Compfight cc
Entrepreneur, Real Estate Investor & Property Services
10 年Hi Mary Pat. Good questions, and great info. I've forwarded your article to several of my clients. Thanks for sharing it.
Clinical Therapist at Footprints to Recovery
10 年Clay S. You're a Surgical First Assistant, working for a medical practice and you employer doesn't provide health insurance? You had to purchase your own?
Special Advisor to the Dean & Chancellor, Ross University School of Medicine, Dominica.
10 年How will OBAMACARE influence the future of medical care in the USA ? I think that lots of the focus in the news media is party politically driven. What do you see as the facts of this 100 year overview of US healthcare as a Physician yourself? What must we tell the US physicians in training whom we teach today ? The economics of course is important. But the system of medical care provided by the physicians themselves, in their Offices, Hospitals, in Public Health Policy, in Physician Advocacy, etc; needs guidance from registered practicing Physicians. Such guidance must be objective, based on data, and reflect medicine as seen through the eyes of Doctors working for the betterment of all those for whom they provide care and guidance, and daily advice, and I daresay future planning. I just returned from the Annual ACP conference in Orlando, so I am all worked up, and in the reflective mode at this time.
Customer Servicee Associate at Walgreens
10 年Thank God I did not elected to have my AVM brain surgeries (2 strokes during 7 brain surgeries in 1990) NOW, with Obamacare! I would not have this 2nd life that I now have!! My medical-mayham was way over a million dollars, and I DID have excellent insurance.
CEO, MHNR Network
10 年Mary Pat Whaley, FACMPE, CPC I would love to know how ACA is changing the way behavioral healthcare providers will and are doing business.