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How to overcome 90 day ACA grace period payment delays

How to overcome 90 day ACA grace period payment delays

One aspect of the current administration's Affordable Care Act may have your medical office very concerned. Essentially, a 90 day grace period for enrolled members means that there is a 60 day window where insurance companies can pend claims depending on ultimate actions by the patient. If a patient drops insurance after that window, these claims may be denied by the insurance company. This could mean a significant slowdown in cash flow to you.

Here are some ways you can overcome this challenge, and many of the tips are recommended best practices for medical revenue control in general.


Do

Do create a before the front desk approach

Make more of your practice’s financial policies and patient responsibility obligations a discussion that patients have with trained staff members before care is given. Speed the registration process by holding these conversations and providing a method for patients to complete registration forms prior to their appointment date. Expected required payments at time of service could include existing balances, co-pays, estimated co-insurance/deductibles, and services not covered by insurance. Be sure your forms clearly reflect your practice’s policies, are updated regularly, and signed routinely by your patients.

Do pre-verify insurance

Doing more of the desk work around insurance policies and timelines before or on the date of service is a good way to minimize liability around the ACA 90 day grace period. Payors are also supposed to notify you when a patient has missed their premium payment; make sure this is communicated to the appropriate staff member. With more individuals changing plans, this is also a good way to identify any non-coverage or out-of-network issues before the service is rendered.

Do discover new ways of collecting revenue

This is a key way that providers are handling their liabilities. Although there is a limit to what medical providers can do to obtain money upfront, the signing and enforcement of financial responsibility paperwork is one step in the right direction, as is a solid credit card on file approach. Look into federal and state laws regarding the do’s and don’ts of collecting more upfront revenue to hedge against ultimately denied claims under the ACA grace period.

Do ask patients to talk to insurers

Sometimes your patient is your best advocate to receive reimbursement from the payor. A lot of non-collected revenue and patient/medical office frustration is a result of miscommunication or delay tactics from insurance reps. When patients are also engaged with their benefits administrator, some of these problems with non-payment can be avoided. You may also want to assist your patients by creating letters for their use that they can sign and submit to their carrier. When speaking with insurance reps, advise your patients to request a reference tracking number and retain a contact tracking log for outstanding issues.

Do delegate work and assign ownership

One of the biggest problems for providers is when they know they need to do all of the above things, but no one is around to do them. It's a fact that all of the upfront work around limiting liability will take staff hours, and it will also require people being assigned to these duties. It’s also a fact that not having these measures in place will reduce revenue and increase time spent on the back end tracking down eligibility and payment delays. Providers who don't change their office model are largely unable to adapt to the new realities around the ACA, while those who put people in charge of complying with their own office policies are much more likely to succeed.


Don't

Do not skimp on training

The folks you delegate to do the necessary steps to effectively run your practice will require tools and resources. Break down your process as is and compare it to the ideal model. This will identify gaps and redundancies, pinpointing your team to a successful outcome. Along with enabling change in your medical office model, you may determine a significant investment in training is required, roles should be revamped, or new recruits brought in who have the inner drive, attitude and follow through to support your vision.

Do not react with attitudes that patients perceive as unfriendly

Taking an aggressive, rather than an assertive, approach toward patient finances can frighten off a lot of patients and cause a big blow to a provider’s overall reputation. Rather than going after collections aggressively, changing the office model will allow providers to manage their revenue cycles in a way that retains patient engagement. Again, training key staff on what to say and how to ask the difficult questions is vital to your business.

Do not outsource collections without due diligence

While outsourcing some aspects of medical billing to a third party company can be an effective way to deal with ACA changes and more, physicians and practice managers should always work very closely with third party collectors and understand what they're doing on their behalf. Working with incompetent or unscrupulous third parties can land you in even bigger problems in terms of liability and perceived local image.

Do not wait

As with other kinds of new regulations and changes such as meaningful use measures, ICD-10, and legal requirements to meet patient privacy, providers who push implementation into the future will often find they have delayed until it is too late. Take on these problems head-first with as many resources as you can spare. Long-term, you may find your operation is much more streamlined and more easily adaptable to new circumstances.

Do not ignore your practice’s culture

Like any business, a medical office has its own culture, and this will influence how everyone addresses the issues of the day, from the front line to top management. Team meetings and other kinds of adaptation can help the office devise solutions and collaborate better as a whole. If you find yourself with one or two individuals resistant to change or non-supportive, realize they are not the right fit and most likely affect productivity or attitudes of others. Fit individuals to your practice’s philosophy vs. the reverse. While it may take time to replace resources, you and your remaining staff will be better off.


Summary
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Taking these steps upfront may seem like a heavy burden to bear, especially when the majority of practice resources are stretched thin. However, medical offices that have undertaken these measures will be prepared for the future, limit their liability, and operate more resourcefully.


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Sue (Sunni) PattersonPresident/CEO

Sue (Sunni) Patterson started in the healthcare industry as a senior medical claims processor with a major insurance payer. Sunni is President of RMK Holdings Inc., a healthcare revenue cycle management services firm. Key specialization areas in...

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