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Health insurance exchange plans present concerns for physicians
e-Reports, Nov. 12, 2013
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Note these six things you can do to prepare as January nears Untitled document

The AMA, state medical societies, hospital systems and physician groups are voicing complaints about insurance plans and processes coming from the health insurance exchanges. While many work to change and improve things, you can take some steps now to help your practice through the uncertainties to come. Here are six to get you started.

  1. Review your capacity and payer mix – The state says up to 300,000 Hoosiers could be insured for the first time because of the Affordable Care Act (ACA). That potentially means more patients for your practice. Perhaps, that’s a good thing, but you need to examine your capacity to accept new patients. Also, look at your payer mix to be certain you are getting patients with payers that don’t threaten your practice’s viability in the long run.
  2. Scrutinize current and potential contracts – While it’s always best to carefully review contracts, the practice becomes more important with the introduction of new plans from the health insurance marketplace. Also, review your current contracts, paying attention to all-products clauses. Communicate with insurers’ provider representatives to get your questions answered before January.
  3. Prepare for the grace period – One anxiety-producing provision of the ACA is the 90-day grace period patients have to submit premiums. Though it’s a benefit for patients to have this payment window, the provision puts you at risk. Insurers must pay all claims within a month, but if the patient still has not paid the premium by the second month, claims will be held. If the patient does not pay by the third month, a plan termination will occur and you will need to return money from any claims paid – and then collect the amount due from the patient.
  4. Train staff on eligibility verification – Because of the grace period noted in No. 3, your staff will need to verify eligibility on every visit. Also, advisors suggest making certain contracts stipulate that insurers notify your practice when a patient enters the grace period.
  5. Plan to capture patient out-of-pocket payments – Now is a good time to review your procedures for collecting payment. Are you succeeding at collecting at the time of the visit? That may become important as high-deductible health plans become more commonplace. Getting paid later – involving statement mailings, letters and even collection agencies – is much more difficult than getting payment on the day services are delivered.
  6. Stay informed – Things will change as the ACA is rolled out; many details and deadlines have already been modified. Keep reading ISMA Reports, e-Reports and checking the ISMA website. Also, ask your staff to do the same.

If you have contracting or Medicare/Medicaid questions, call the ISMA staff for assistance at (800) 257-4762 or (317) 261-2060.

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