Medical Billing Forum

Billing => Billing => Topic started by: PMRNC on January 24, 2014, 12:44:58 PM

Title: A MUST know NOW as a medical biller
Post by: PMRNC on January 24, 2014, 12:44:58 PM
There’s a lot of talk and controversy over providers and their right to “opt out” of exchange plans. It's getting to the point in this industry where medical billers MUST know credentialing to some degree.  For many months leading up to the 1/1/2014 date, I've done nothing but review contracts, analyze providers status and dependency on Medicare/Medicaid. Yet here we are almost to the end of January and there are still so many providers thinking they can just "NOT TAKE" "Obamacare" patients. It is not quite that simple.

It’s important to note that there is NO ONE plan to opt in or opt out.  There is NO SUCH THING AS "OBAMACARE". How it works and something that should have been done in the 6 months to a year leading up to the kick off of the exchanges, was to review all existing provider contracts, you want to look for a clause or omission of the “ all product clause” which would entail a provider to honor their existing contract for all plans under that one contract. In some states providers can refuse an all product clause (example; Florida) however many providers may not know that. If a carrier has the “all product clause” providers are required to accept any and all patients covered by that plan including exchange enrollees.

Once you have gone through all provider contracts you will have a MORE clear picture in regards to the exchange plans. If your contract does not have an “all products” clause, it will usually list the exact plans that contract covers. If you come across a patient with an exchange plan for a carrier that does not have an “all products” clause you can then see if the product the patient has is one included in your contract.

We have updated our subscriber area for more information on participating provider contracts, sample "All products clause" verbiage, and list of the states that limit or prohibit "All product clauses".
Title: Re: A MUST know NOW as a medical biller
Post by: shanbull on January 24, 2014, 01:26:34 PM

So ridiculous! I can't believe how many people who should know better actually think these are plans from the government labeled "Obamacare" instead of through the same private insurers everyone is already contracted with. Especially now that these plans are active! I bet a lot of these doctors have already treated people with new exchange plans and they didn't even realize it.
Title: Re: A MUST know NOW as a medical biller
Post by: PMRNC on January 24, 2014, 01:31:01 PM
It is just blowing me away that they are NOW starting to wonder what's going on.. this was something we knew about over a year ago..I really believe people didn't take proper steps because they thought it would be re appealed.