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.pageInterested in any feedback and thanks!
Heidi Kollmorgen, CCS-P