The AMA just announced that physicians and other providers participating in the federal and state health insurance exchanges may not be paid if patients don’t pay their premiums due to a 90-day “grace period” before the policy can be canceled. The AMA says this is a “little known” rule. Hundreds of thousands of physicians and other providers eschewing exchange patients have known this since 2010. Physicians and providers who did not know, need to.
That’s because the Affordable Care Act gives people signing up under healthcare.gov or state insurance exchanges three months to pay their premiums, and to be “fully insured” during that period whether they pay or not.
Insurers are on the hook for benefits for the first month, and providers for the other two. In fairness, insurers are supposed to notify providers if premiums have not been paid. In reality, the programming that is supposed to provide that information largely hasn’t been written yet and what has doesn’t work so well.
Insurers are indemnified for 80 percent of any losses by law. Physicians and other providers are on their own.
Considering that pre-existing conditions must be covered by law, this 90-day free ride can run up some real bills and stick you with them even though services were approved by you in good faith. “Good faith” is the part insurers and providers are bound by, but the exchanges are not.
So, how can practices protect themselves, short of dropping out of exchange plans?
Legally, you can’t other than requiring copays and deductibles at the point of service to mitigate the risk.
For those of you who have been excluded from the insurance exchange plans, a thank you note to the insurer is probably in order.
Those of you who have been included in insurance exchange plans need to continue with open eyes, extreme caution, and ensure your voter registration is in good order.
Candidates promising to fix the multitude of unfunded mandates are sure to be popular in the healthcare community

By: James Doulgeris

– Source: http://www.physicianspractice.com/medical-billing-collections/obscure-obamacare-rule-puts-many-physicians-financial-risk#sthash.BKMlT2db.dpuf

Statement attributed to:
Steven J. Stack, MD

Immediate Past Chairman of the Board of Trustees, American Medical Association

“The American Medical Association (AMA) appreciates the changes proposed by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) yesterday to make it easier for physicians to achieve Meaningful Use. However, our chief concern remains unaddressed and we worry that current requirements will slow the adoption of technology that will help coordinate care and improve quality and that many physicians will drop out of the Meaningful Use program if the current all-or-nothing approach remains in place. To date approximately twenty percent of eligible professionals – mostly doctors – have dropped out of the program and we expect this number to grow unless more changes are made.

“A recent RAND Health reportExternal Link commissioned by the AMA reflects physician dissatisfaction with the Meaningful Use program and accounts for some of the reasons many are dropping out. It found that physicians feel the Meaningful Use program is burdensome and, in many cases, doing nothing to advance patient care. Allowing physicians who are having difficulty updating software to use electronic health records that have been certified for the 2011 Edition for 2014 and giving them an additional year to achieve Stage 2, could help more physicians meet the program requirements and avoid a financial penalty in 2015. Although those proposed changes are helpful, we believe the current requirements, particularly for Stage 2, still remain a longshot for many doctors to meet.

“We recommend that CMS and ONC replace their all-or-nothing approach with a 75 percent pass rate for achieving Meaningful Use. Additionally, we believe that physicians who meet at least 50 percent of the Meaningful Use requirements be able to avoid financial penalties. Absent this type of flexibility, we are concerned that the Meaningful Use program may falter irreparably.

“We also recommend that CMS better align quality reporting programs. The rule proposed yesterday does not adequately address reporting clinical quality measures because physicians still must report separately for Physician Quality Reporting System (PQRS), Value Based Modifier (VBM) and Meaningful Use programs to avoid penalties and receive incentives. That inefficiency places an additional burden on physician practices that does not improve care.”