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obama care act

Paula Posted Thu 21st of August, 2014 16:52:17 PM

It is going to be harder to bill because of the OBAMA CARE ACT. Plans will be different but
I am not understanding why it will be difficult to get claims processed in a timely manner since we are not
billing ICD-10 yet.
I am hearing that there will be a lot of errors because of the new rules. WHAT NEW RULES ?
How do we protect our practices ( getting paid.)
So many plans will need to be verified
that the patient has insurance for that date of service-never assuming the next visit will be covered.
3 month rule. Plans will pay at 60, 70, 80 or 90 % depending on plan selected.
We Collect the % up front at time of service. We do bill the claim and if it goes to the ded for that year
the patient gets the bill-
What are the changes for Oct 2014 ( when Obama goes into affect. )
We are a primary care and and family practice and office.

SuperCoder Answered Thu 21st of August, 2014 22:23:44 PM

Thanks for your question. The Affordable Care Act of 2010 provides many patient protections such as eliminating pre-existing condition insurance denials, eliminates lifetime limits for coverage, regulates annual limits, provides access to primary care providers among many other provisions.

In October 2014, insurance plans will no longer be able to renew policies that are not in compliance with the Affordable Care Act. This will require providers to verify insurance when patients come into the office as well as possibly educating patients on insurance as this will be the first time some patients have had insurance coverage. At the time of insurance verification, you should determine the amount that the patient will be responsible for just as you would currently do for your insured patients now. The timeliness of insurance processing still should not change as long as your practice sends out clean claims. In reality the Affordable Care Act should cause an increase in patients seeking primary care physicians.

When ICD-10 is mandated in October 2015, you may face some challenges in claims processing. This is why you should prepare now and make sure that your practice has a plan in place so that there will be minimal changes in your cash flow during the initial transition. will continue to provide information on ICD-10 as the date draws near. Please see attached link for more information on the Affordable Care Act timelines and features. Hope this helps.

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