Preparing your practice for the workflow and financial challenges of Obamacare

With millions of newly insured patients entering the healthcare system in the first round of Affordable Care Act (ACA) enrollments, there will be patient confusion in the first months of implementation. Physicians should be prepared to deal with insurance eligibility questions from patients and, the consequences of the ACA premium grace period.

Primary Care physicians are about to find out to what extent millions of newly insured ACA patients will impact the workflow of their practices, including new patients who have not been to an office visit in years, if ever, and don’t understand how the process works.

Other ACA consequences could impact practice finances, including dealing with a large number of patients with high-deductible health plans and the 90-day grace period for patients who do not pay their premiums.

1. Questions about insurance coverage

Many patients who signed up for coverage in December may not have insurance identification cards yet, but they still may be calling to make appointments.

But what options do physician-owned practices have when scheduling patients who say they have insurance but have yet to receive identification?

Experts say that practices should prepare to spend even more time verifying coverage, and must consider using cash reserves to float payments for the next few months.

“Make sure your practice credit line has money available and take cash or credit cards,” says H. Christopher Zaenger, CHBC, a consultant with Z Management Group in Barrington, Illinois, and a Medical Economics editorial consultant. “Copy all the information on patients cards and for those who do not yet have cards, get their application paperwork and the plans they are joining by specific name and number, then go to the Qualified Health Plans website and verify the coverage and effective date.”

Depending on whether your patient has a plan run by the state or federal government, the verification process will be different. If your state has a federal-run marketplace, it is best to call customer service for the plan to verify coverage. A database of health plan contact numbers is available online at http://1.usa.gov/1lYOVqZ. Find contact information for state run plans on the left side of the Healthcare.gov website.

It will also be up to practice staff to continually educate patients about their payment responsibilities.

“Remind your patients to keep all of their paperwork and receipts from all of their doctor’s appointments and from the pharmacy as well,” says Reed Tinsley, CPA, a healthcare consultant in Houston, Texas. “They may need them for their insurer. Remind them they should carry their card at all times. If they don’t have a card, they can contact their plan to get a card.”

National chain pharmacies, including Walgreens and CVS Caremark, have received media praise for offering patients with new or transitional insurance plans a 15- to 30-day supply of prescription drugs with no upfront cost.

2. Dealing with the 90-day grace period

A provision in the ACA that could cause problems for primary care practices is that patients will be allowed to keep their health coverage for 90 days even if they don’t pay their premiums.

While the ACA requires insurers to reimburse providers during the first 30 days of the 90-day grace period, insurers won’t be required to pay for claims during the final 60 days. This means physicians may provide healthcare to patients in the next few months that they are never reimbursed for, thus requiring physicians to collect money from the patient directly.

Medical groups including the American Medical Association (AMA) and the Medical Group Management Association (MGMA) have taken issue with the grace period rules, arguing that insurers should be on the hook for those payments, not providers.

At the very least, medical organizations say, payers must give providers notice about patients who have entered the grace period and are in danger of non-payment of their premiums.

“A certain amount of people are not going to pay,” says Gray Tuttle, CHBC, a principal at Rehmann Healthcare Advisors in Lansing, Michigan, and a Medical Economics editorial consultant. “Some physicians are going to have to repay insurance companies. It’s going to sting, particularly when the insurance companies start demanding repayments.”

Physicians have limited options for dealing with the grace period, which could last until mid-2014 for patients who buy coverage before open enrollment ends March 31.

Tuttle says physicians can ask patients upon registration whether their coverage is paid for. Another option is to set up credit card authorizations for future payment, so that once an insurance claim is adjudicated, the patient’s remaining balance can be put on the credit card.

The major caution, Tuttle advises, is to make sure physicians stick with the requirements of a patient’s health plan when asking for payment up front.

Tuttle says he does not anticipate too many issues resulting from the grace period, but as with other ACA changes, “It’s another area for cautious preparation.”

3. High-deductible patients

More patients are expected to use high-deductible health plans in the future, a trend only exacerbated by the ACA’s insurance exchange. The cheapest “bronze” plan often can have deductibles above $4,000, according to an analysis from Avalere Health.

The best way to handle patients that may owe your practice is to communicate with patients, experts say. Practices should have a policy in place, and payment expectations and options need to be discussed with patients before care is received.

“There needs to be internal training and education with staff about how to communicate upfront payments,” says Nate Davis, a product manager with ZirMed, a healthcare information technology and management solutions company in Louisville, Kentucky. “There are plenty of payment plans possible that will work with patients with high-deductible plans.”

Adds Tuttle: “If practices know [their patients] are in high-deductible plans, they should be collecting copays and deductibles all along.”