Medical billing challengesPractices face new challenges in collecting patient responsibilities in 2014 under the Affordable Care Act, and the majority of providers may not be aware of the problem.

81% of physicians don’t feel they have enough information on the ACA to understand its impact on their practice and comply with its requirements, according to a survey by QuantiaMD, a social learning network for physicians.

Unfortunately, this lack of information could be extremely costly for providers due to the grace period allowed for patients to pay for their insurance coverage. 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. The ACA loophole that allows for unpaid care for health exchange patients gives patients a three-month grace period before the insurance policy is canceled.

“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,” warns Litten.

Depending on the number of ACA patients your practice sees, this could pose a significant problem for your medical billing and cash flow. Here are some steps you can take to mitigate the problem:

What to do 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. Make sure patients sign a copy of the financial policy or a new patient form that includes a statement that any charges not covered by insurance are the responsibility of the patient/guarantor, including any fees incurred if turned over to collections. 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. Revenue cycle management consultants recommend that organizations should set a target of collecting 95% of co-pays at the front desk and work toward that goal. 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. Consider collecting payment for treatment of new patients up front for the first 90 days. Explain to the patient that you are billing the insurance company as a courtesy to them, but payment is required at time of treatment. This can be a big change for many practices, but in light of the ACA issue, may be necessary for these new patients. Using your MediTouch® collections module, you can also set different collections protocols for this specific group of patients.

  4. 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? Let us know in the comments box below.