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How Can Obamacare Affect Your Practice?

by Mary Pat Whaley, 4.15.14

With three months of the Affordable Care Act (Obamacare) under our belts, we know how the exchange plans are affecting medical practices and we know what changes medical practices must make to stay afloat in this sea of change.

Practices: Confusion About New Plans

Some practices are not clear which payers have offered exchange plans in their states and whether the practice is taking the plan by default due to an “all products” clause in a current contract or by a separate decision that the practice has made to take the plan based on reimbursement.

Patients: Confusion About New Plans

Patients who have not had insurance before, or who have not had high-deductible plans before, may not realize they are responsible for first-dollar payment for care until their deductible is met.

The 90 Day Grace Period

Payers are required to pay their portion of the claims for any services during the first 30 days, but are not required to pay any claims submitted during the remaining 60 days until the premium has been paid by the patient.

How Can Practices Deal with the Changes?

1) Review all current payer contracts and make sure you know what you are being paid by each plan. Are you being paid the same by exchange plans as you are for non-exchange plans offered by the same payer?

2) Don’t have more than 30% of your business with any one payer if you possibly can. Don’t put all your eggs in one basket.

Mary Pat Whaley, FACMPE, CPC is a Physician Advocate at Manage My Practice. She creates sustainable financial viability for small independent physician practices because she can’t imagine a world without physicians practicing medicine the way they want to. Her consulting group has a combined 45+ years of experience in healthcare in private physician practice, hospital-sponsored practice and ancillary business lines.

Author: pehradmin

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