Author Topic: ACA Grace Period - How will this affect Billing Services?  (Read 1998 times)

HeidiK

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ACA Grace Period - How will this affect Billing Services?
« on: March 20, 2014, 01:14:55 PM »
Hi Everybody!

I've kept up with this topic and wondered how everyone is handling this situation as we had into the third month of this year.

The Affordable Care Act provides a 3 month grace period to pay premiums for coverage purchased through healthcare.gov.  The rule explains how claims received will be "pended" if the patient is thirty days past due on their monthly premium payment.  If the payment is received, claims will be released however, if the premium is not caught up and paid in full after 3 months, claims will be denied leaving the doctor to try and collect the money from the patient.  As a denied claim, the full charge of each line item would become the patient's liability but what are the chances they will pay if they haven't paid their premium?

My question is to anyone who might have approached this with their doctors/clients.  As a medical billing service, you have put the work in to file the claim, checked status and kept track of the claims but if the doctor doesn't get paid are you setting up a different arrangement for this situation?

I guess it ultimately depends on how you charge - if it's at a percentage of collections you won't be paid but if it's at a hourly or flat-rate fee how will you approach this if the doctor doesn't want to reimburse you for work he/she won't get paid on in the end?

It may not seem significant this early on although with such a strong push to get so many people signed up I would predict it will become an important issue to factor in for any practice.

Here is one link to the AMA's guidance on the matter - I'm not sure if the "additional resources" link works for non-members but googling the topic brings up many other sites as well.

http://www.ama-assn.org/ama/pub/advocacy/topics/affordable-care-act/aca-grace-period.page

Interested in any feedback and thanks!

Heidi Kollmorgen, CCS-P
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com

RichardP

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Re: ACA Grace Period - How will this affect Billing Services?
« Reply #1 on: March 20, 2014, 02:58:29 PM »
Just to be clear, the patient must pay at least the first premium before s/he becomes qualified for the grace period.

We've briefly discussed this subject before at this link:

http://www.medicalbillinglive.com/members/index.php?topic=7601.0

HeidiK

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Re: ACA Grace Period - How will this affect Billing Services?
« Reply #2 on: March 20, 2014, 03:49:36 PM »
Thanks Richard!  I read the post you referred to but I guess I just wanted to bring it up again.  I was really interested in seeing if anyone has had a conversation about this with their doctor/client and what was ultimately decided?  Just trying to get some feedback so I'm prepared for the inevitable.  : )

Thanks again!
Heidi Kollmorgen, CCS-P
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com

PMRNC

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Re: ACA Grace Period - How will this affect Billing Services?
« Reply #3 on: March 20, 2014, 04:16:05 PM »
What I have done with my clients before 1/1 was sit down with them and go through all par contracts. Then we came up with a plan for the situation with the grace periods. My clients are asking clients with an ACA exchange plan or ANY individual plan to bring in confirmation of payment premiums for the current month. We also modified all practices policies/procedures for benefit verifications as well as office financial policies to address this issue along with the higher deductibles in addition to the grace period thing. I don't bill on a % anymore and haven't but I suppose this would be one more reason why it might be good time to convert over.. what a pain that is going to be dealing with it on the office level and then for your level as a billing company. I'd guess you could do a credit for the monies the carriers recoup or take precautions like we have to prevent it from happening either way.   If a patient does NOT bring in their premium payment confirmation they must pay the balance in full and we will reimburse them if carriers we par with do pay.

If you have ever dealt with a COBRA patient where you verified benefits and then the patient didn't pay premium so carrier recouped later on.. this is basically same thing. When we verified benefits for a COBRA patient we also had them bring in current premium confirmation.    Don't look for the carriers to fix this because they can't. All policies have grace periods, the problem lies with the ACA provisions and 90 days.. our govt at it's best as usual.  ::) :-\
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RichardP

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Re: ACA Grace Period - How will this affect Billing Services?
« Reply #4 on: March 21, 2014, 01:16:56 AM »
If a patient does NOT bring in their premium payment confirmation they must pay the balance in full and we will reimburse them if carriers we par with do pay.

I'm curious what your defense would be if you get sued by the carrier(s) you are par with.  I'm sure that charging the patient more than the allowed amount violates the terms of the contract with the carrier you are par with.

PMRNC

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Re: ACA Grace Period - How will this affect Billing Services?
« Reply #5 on: March 21, 2014, 09:18:22 AM »
Quote
I'm curious what your defense would be if you get sued by the carrier(s) you are par with.  I'm sure that charging the patient more than the allowed amount violates the terms of the contract with the carrier you are par with.

I'm not showing where I said we charged more than the allowed amounts, however with all of my clients we have been preparing for this and other contractual issues since Sept/October. The grace periods were in place over 2 years before everyone started worrying about it. All of the carriers we participate with and have contracts with are with "Actively" insured, for the policy and our contract to be binding the patient needs to confirmed as eligible. That would be our defense.

 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com