Three Ways Medical Practices Should Prepare for Insurance Exchanges

October 16, 2013

Don't let health insurance changes in 2014 harm your bottom line. Here are three action items to consider.

It's been about two weeks since individuals began enrolling in health insurance exchanges, and it's less than three months until those plans kick in.

That means many new patients with new insurance - and new types of insurance - may soon visit your practice. If your practice is not prepared, it could miss out on getting paid what it is owed.

Here are three ways practices can prepare for, and adjust to, the influx of new patients with new insurance:

1. Educate patients. Since enrollment in exchanges only recently began, it is still too early to tell exactly how plans through the exchanges will pan out, Donna Kell, president of Pittsburgh-based medical billing and consulting company The Kell Group, LLC, recently told Physicians Practice. Still, she said, from a preliminary overview it looks as if patients insured through exchanges will shoulder more of their healthcare costs.

"The way the policies are written is going to be totally different," said Kell. "I don't think there are going to be any policies written anymore where once you meet the deductible there is absolutely no out of pocket."

For that reason, she said practices must step up patient education regarding insurance and payment. "I think the most important thing is educating your patients and reminding them to contact their insurers, making sure that they understand their benefits, and not be surprised by the fact that they're going to get a bill from us or they're going to be asked up front for a certain amount of payment."

Also, Kell said, practices must educate patients regarding insurance terminology such as how deductibles and co-insurance works. To save time, consider creating a handout to provide patients regarding how benefits work and key questions to ask insurers.

2. Educate staff. As more patients become newly insured, more will have questions for practice staff regarding benefits and coverage. For that reason, practices should begin providing staff with more education regarding how insurance works, said Kell.

"I think a lot of times people who work in a medical practice, their job is narrow in scope and they don’t view part of their job as really understanding the big picture," she said. "I think with the Affordable Care Act, it's going to be required that anybody who works in that practice really has a broader understanding of how that insurance coverage works and what are the nuances of it."

3. Step up insurance verification. Verifying patient insurance and coverage information upfront may become even more important for practices moving into 2014. That's due to the number of newly insured patients practices will attract, and the growing number of plans that are available to patients, said Kell, adding that practices should step up training to ensure staff is verifying patient information appropriately each and every time.

"[Insurance verification] has always been really important and, in my experience, it’s often the thing that causes doctors to not be paid or to be paid late," she said. "They don’t get their payments quickly because the staff hasn’t done their job checking that the patient is covered by that insurance card [that] they're looking at, and that the service they are providing is a covered benefit for that patient."