ACA burdens mount for practices

Although practices handled the relatively low volume of newly insured health-exchange patients smoothly at first, some offices struggle to keep up with verifying new enrollees' coverage, according to Kaiser Health News.

"We had a spattering [of new patients] in January--maybe once a week. But I think we're averaging two to three a day now," Sheila Lawless, office manager at a small rheumatology practice in Wichita Falls, Texas, told KHN. And for each of these patients, office staffers spend at least an hour on hold with the insurance company to verify that the patient's coverage is effective and the premium is paid.

The latter issue creates a time-intensive process for practices. The 90-day grace period before policy cancelation due to nonpayment included in health-exchange contracts means practices risk losing money on claims incurred after day 30.

To avoid this risk, Lawless contacts insurers to make sure new patients are up-to-date on their premiums before proceeding with the visit. If they are not, Lawless gives the patient the option to reschedule the appointment or pay in cash and then apply to his or her insurer for the payment. 

This work places a significant burden on the practice, Lawless told KHN, as she's had to reorganize staff and pay them to work longer hours to make sure the office keeps up with the new workload. Similarly, payers report adding staff to handle the call volume influx.

Even if patients verify they paid their premiums, that may still not be enough to prove coverage if they just enrolled, thus necessitating more legwork and patient education on the part of the practice.

That's because, depending on the date patients purchase a policy, it can take up to six weeks for coverage to kick in--a nuance the government didn't communicate to the public, according to Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association. "What we've found is that messaging out of the [Obama] administration right now that's aimed at the public, it tends to oversimplify the complexity of what it takes to get covered on the exchanges," Gilberg told KHN. "Just because you enrolled in coverage doesn't mean your coverage is effective." 

To learn more:
- read the KHN article