Under the Patient Protection and Affordable Care Act, patients who purchase subsidized coverage through the exchanges are given a 90-day grace period before their coverage is canceled for nonpayment of premiums. Insurers are permitted to make pending any claims submitted for services performed during the last two months of three-month period. They may ultimately deny such claims if the patient does not make the missed payment, and the patient would then be solely responsible for the payment.
Health plans are required to notify providers when one of its patients enters the grace period. However, CMS does not specify in its guidance how or when the health plan must provide the notice.
Here are five ways anesthesia practices can protect their revenues with regard to issues arising from the PPACA grace period:
1. Check with the issuer of the health insurance as to the means by which it will notify providers of the grace period.
2. Check with the issuer of the health insurance as to when it will provide the notice.
3. Ask how to verify eligibility of the patient.
4. Track the notices and eligibility verification responses received.
5. Provide affected patients with information on their rights and responsibilities.
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