Have Your ACA Plan Processes in Place for the New Year

December 17, 2016

Regardless of your political thoughts, no one knows what, when and how the ACA plans are going to play out. Make sure you're prepared.

Open enrollment just ended for plans starting as early as Jan. 1, so have your game face on and your process in place to ensure the transition goes as smoothly as possible.  There will most likely be some bumps in the road, and identifying those processes as soon as possible will save you and your patients' headaches down the road.

Here are some areas to review your procedures to make sure they are up to par:

• Be sure you have a plan in place to re-verify current patients insurance plans, as most all deductibles start over on Jan. 1.  Plans change, as well, so what could have been a $3,000 deductible for 2016 can jump to a $6,000 deductible for 2017. 

• Most employer plans changed as they were also forced to pay higher monthly premiums and in turn, had to choose higher deductible plans for their employees.  Most employees get zero notification of these changes until they get hit with a bill or a much higher cost share at the time of service.

• Pay attention to alpha-prefixes of new plans.  They will give you a clue as to what type of plan the patient has.  It will also help you identify the benefits much quicker and if you are even contracted with the new plan.

• There are several software programs that can assist you with insurance verification.  They provide almost immediate results if you are checking to make sure patients are eligible and their plan is current.  If a patient stops paying their premium, their plan will lapse and then you have to hunt the patient down for payment after the fact.

• Provide your staff the appropriate amount of time to do the verifying.  If you have a large patient population, it's even worth it to hire a temporary employee to answer your phone and collect copays if it provides more free time for the back office staff to get these verifications completed.

Regardless of your political thoughts, no one knows what, when and how the ACA plans are going to play out.  Be ready with a solid payment policy that your patients sign on their first visit.  Be sure your staff know what your cash rates are in case that is the route you’ll need to take.  Lastly, communicate with your patients about their cost-share on the first visit.  Be open, honest and very clear what they will owe.  They may balk at the moment, but they will most certainly be more open to paying their share rather than receiving that large bill.