AMA issues new salvo on ACA’s 90-day premium grace period

While the American Medical Association (AMA) is fighting to reverse the financial risk to physicians over the controversial 90-day premium grace period in the Affordable Care Act (ACA), it just released a series of resources to help doctors if confronted with policy jumpers.

Under the rule, patients who fall behind on their monthly premiums will still be able to keep their coverage for 90 days. During the first 30 days, insurers will be responsible for reimbursing claims for services provided to the patient. But during the final 60 days, insurers may deny claims, and physicians will be responsible for collecting payments directly from patients.

The Obama administration has announced that more than five million people have signed up for insurance on the insurance exchanges. But insurance industry officials told Politico that as of mid-March, between 15% and 20% of people who have signed up have not paid their first monthly premium.

The AMA recently wrote to Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner arguing that CMS has “unfairly shifted the burden and risk of potential loss for patient non-payment of premiums to physicians.” The letter also expresses the need for timely notification from insurance companies about patients who have entered the grace period.

The AMA, along with several other physician advocate groups, have repeatedly argued that insurers should be responsible for payments during the full 90-day grace period, rather than physicians.

“The grace period rule imposes a risk for uncompensated care on physicians so the AMA has created resources to help medical practices navigate the key aspects of the rule to minimize its potential negative impact,” AMA President Ardis Dee Hoven, MD, said in a statement. “Managing risk is typically a role for insurers, but the grace period rule transfers two-thirds of that risk from the insurers to physicians and health care providers. The AMA is helping physicians take proactive steps to minimize these risks.”

Next: Resources to help physicians collect payments

If the policy fight fails, the AMA has provided several resources to help physicians collect payments including:

• A step-by-step guide to the ACA grace period,

• a grace period collections policy checklist,

• model financial agreement language for patients receiving Advance Premium Tax Credits, and

• a sample letter: Grace period notice to patients

The collections policy checklist encourages providers to verify insurance eligibility prior to a patient’s visit and to document the information. It also provides physicians with tips on communicating billing policies to patients and establishing payment plans.