Only months into Affordable Care Act implementation, one of the biggest remaining challenges for physician practices is understanding contracts with new health exchange plans, noted consultant Mary Pat Whaley in a recent Manage My Practice blog post.
This problem is two-fold. First, practices need to get a handle on which contracts they actually take. In some cases, offices may accept health exchange contracts with certain payers by default because of an "all products clause" in their existing contract. As a result, practices need to clarify for employees exactly which plans they accept and what the cards look like.
Next, it's in practices' best interest to take some responsibility to educate patients, especially those who've never carried insurance or high deductibles before, about noncovered expenses that the practice charges. And in cases insurance coverage is denied for services, it's likely worthwhile to educate patients about the appeals process, according to a recent article from Kaiser Health News. What many patients might not realize is that the ACA creates national standards allowing appeals to the insurer and, if necessary, to a third-party reviewer--and that patients win such appeals about half of the time.
During this initial transition period with new health plans and patients, it's especially critical to invest time and resources into revenue cycle management on both insurance and patient receivables, Whaley wrote. And to further protect themselves on the patient-payment side, she encouraged practices to adopt a credit card on file program.