July 07, 2015
The Affordable Care Act (ACA), also known as the Obamacare, first became law in 2010. Since then a lot has changed between physicians and patients. Not only physicians but also the medical billing staff now have to be more knowledgeable about the changes that this Act has brought, as it could cause major risks to their revenue and financial stability.
Individuals who have purchased a health insurance policy are usually treated by physicians who assume that patients are paying their premiums and thus their health establishments will get their reimbursements via the insurers. But what happens when an individual stops paying his health premiums?
The ACA now grants a 90-day grace period for government subsidized plans, i.e. those individuals who have purchased a health insurance through the government, and who receive tax subsidies to offset the cost, under which their coverage cannot be cancelled for non-payment of premiums. The extended grace period rule in the ACA now literally transfers two-thirds of the risk from the Insurer to the physician and healthcare provider. The financial risk kicks in for the physicians and medical billing staff when:
1After the 30 day grace period, during which if claims come in, the Insurer can pay. But, after that, during the 60-day grace period, it is the health care providers who will have to bear the healthcare spending costs, as insurers are not obligated to settle the claims if the premiums cease.
Further, the insurers can hold the claims to wait and see if the policy holders will pay their premiums during the last 60-day grace period
Moreover, it is very difficult for the physicians or health care providers to identify which patients fall into the government –subsidized plans and which of these fall into the 60-day grace period
So as a physician you need to carry forth this 5 point program to help mitigate financial risk to your practice:
Update your patient about the new legislation of ACA as it could affect their treatment, especially if they skip on their health premiums
Enquire about your patients health insurance contract, and elicit as to how they will inform the physician or medical billing staff, and how they will handle the grace period issues if premiums are not paid
Proactively initiate a strategy to help mitigate non-payments from insurers which could be due to cancellation of health coverage of your patient at the end of the grace period
Work out a three way communication between your billing staff, the CMS administrators, and the patient, as soon as patients enter the first month of the grace period
Communicate with your patient who is in the grace period so that it is a win-win situation rather than a lose-lose situation
So updating your patient about the financial risks and their timely payments may help you minimize the negative impact of the ACA on your practice and also on your patient.
ACA / HIPAA / Reforms