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How Will Newly Insured Americans Affect Doctors and Practices

November 18, 2013

Much of the media’s focus of the impact of the Affordable Care Act (ACA) has been on the patient-consumer, with the proposed wider spread of cost and risk among the population aimed at driving down premiums while increasing the availability of covered services.

Many physicians and other health care providers are left wondering where they fit in the equation: will they see an increase in patients, and if so, will this mean the need for extra staff to handle the influx? Or, as some specialists suspect, will this mean a reduction in services and slower out-of-pocket payments as patients are now being asked to bear a higher share of the copay and deductible?

There are several important areas in which the ACA will impact health providers and practices:

Creating an increased need for health care services

Starting in 2011, the ACA mandates the inclusion of 63 reimbursable preventive services with no out-of-pocket expenses to the patient, such as blood pressure and selected preventive screenings, including mammograms and childhood behavioral testing, certain immunizations, and access to contraception. For family, and similar primary care practices which may have had difficulty with obtaining reimbursement for these services in the past, this may be good news.

In January, 2014, the ACA will add mental health services, maternity coverage, rehabilitation and chronic disease management, and medications to the list of reimbursable covered services. Insurers cannot exclude patients with pre-existing conditions from obtaining insurance, nor set annual or lifetime coverage limitations.

An influx of new patients

All of these changes should bring in many new patients who were previously shut out of the health care system, as well as bring about an increase in services to current patients – good news for many practices. The biggest increase is expected to be among the poorest segments of the population, those whose incomes are at or below the federal poverty level.

On the other hand, there are those practices which are already at capacity for adequately caring for their existing patient load, and which do not wish to add new patients. These physicians may be thinking twice about joining exchanges for at least four reasons:

  1. Most exchange plans have so far not posted the new physician reimbursement rates, making it unclear whether these new rates would be competitive with previous commercial plans.
  2. Some exchange plans have cut higher-priced hospitals and others out of the networks, rewarding those which do discount with more patient volume. These discounts may be rejected by many physicians, resulting in some plans to put pressure on providers to sign up in order to offer enough physician choices for new members.
  3. Uncertainty among physicians about how the number of prospective new patients between the start of enrollment in October, 2013, and January, 2014 will affect their staffing requirements.

Higher out-of-pocket expenses for patients may create payment problems

Even before the ACA, the trend has been toward patients assuming a higher share of the copay and deductible. Most of these increases impact some specialty practices, with high-priced services such as orthopedic surgery, more than others.

Deductibles will vary depending on the type of plan as well as on services provided. It may become necessary to collect those charges or work out a payment plan with the patient at the time of service.

M-Scribe Technologies, LLC, a leader in medical billing, coding and documentation, can help your practice navigate the array of new insurance regulations, billable charges and claims management. Contact them today for assistance with all of your health claims and documentation compliance concerns.

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