Most providers are not aware of the problem their practices may face in collecting payments in the first quarter of 2014 under the Affordable Care Act.Due to the grace period allowed for patients to pay for their insurance coverage, payment of claims is hazy for newly-covered patients. This grace period could mean that insurers balk or refuse to pay claims for patients who have stopped paying premiums.
As the Texas Medical Association noted on its blog, “Federal regulations give patients in health insurance exchange plans three months to pay their premiums. For the first 30 days of patients’ coverage, the insurers are required to pay claims under the federal regulations and accept the government advance tax credit as payment of the premium. However, for the last 60 days of the grace period, there is no such mandate. If the insured person does not pay his or her premiums within the grace period, the law does not require the insurer to cover any services the physician provided during months two and three.”
Attorney Elizabeth Litten, of the law firm Fox Rothschild LLP, was quoted in Medical Practice Compliance as saying that “the Affordable Care Act will create billing compliance difficulties… It is still unclear when and how practices can bill patients directly once insurers determine the patients are no longer covered, putting practices at risk of not only revenue loss but violating debt-collection practices.”
How to protect your practice
1. Have a financial policy clearly stating what the patient responsibility for payment is and the consequences for violating the policy. MediTouch® makes management of your collections easy with our built-in collections module; you can set your own rules for flagging accounts and follow-up protocols, as well as upload your own collections letters.
2. Collect co-pays at time of service. Your chances of collecting after the patient leaves the office drop to less than 40%, while your chances of collecting before the patient sees the doctor are greater than 80%; so it’s vital to require payment of co-pays before the patient sees the doctor. MediTouch® helps you ensure the collection of co-pays by providing the co-pay amount and a prompt to collect during the check-in and check-out workflows.
3. Be sure to check eligibility. Eligibility checks will be vital until these issues are sorted out. MediTouch® offers a unique tool for this; our medical billing software provides the ability to schedule eligibility checks at a specified time before appointments, allowing you to contact patients whose coverage has changed before they are seen and make payment arrangements when necessary.
If you are accepting more than a minimal volume of patients covered under new ACA policies, it is wise to consider the financial implications for your practice and act accordingly. Were you aware of the grace period issue? If so, how is your practice handling it?
