21 May 2014


Original Story:  DetroitNews.com

A quirk in Obamacare has doctors throughout Michigan worried they’re going to be stuck with unpaid bills or forced to become bill collectors when treating patients.

The Affordable Care Act, in a rule published by Centers for Medicare & Medicaid Services, dictates that patients enrolled in government-subsidized health plans — individuals who have purchased a plan from the marketplace and receive a tax credit for it — have their medical bills covered by insurers for 30 days.

But during the following 60-day grace period, insurers may “pend” or hold off paying the claims and, ultimately, deny payments if the patient doesn’t catch up on his or her premiums.

That means doctors will get paid only if they collect directly from the patient long after an appointment, a move that the American Medical Association says “could pose a significant financial risk for medical practices.”

The AMA is so concerned about this rule that it’s created a step-by-step guide for its physician members to minimize their risks, and it includes a “Dear Patient” notice to mail. And some doctors have been reluctant to treat patients with plans they purchased from the marketplace — resulting in less access to health care for consumers.

“Managing risk is typically a role for insurers, but the grace period rule transfers two-thirds of that risk from the insurers to physicians and health care providers,” said AMA President Ardis Dee Hoven in a statement.

Previously, insurers generally would cancel a policy if a subscriber fell behind more than 30 days, rather than the ACA’s 90 days. The insurer, rather than the doctor, would be responsible for bills incurred before that cancellation.

With the new grace period, the burden is shifted to the doctors and their billing departments to collect money that a patient owes. Doctors’ offices are likely to to hire bill collectors if initial efforts to collect for unpaid services are unsuccessful. Doctors’ offices have financial counselors to help uninsured patients come with payment plans.

“We’ve been talking about this rule for more than a year,” said Dr. Randall Bickle, a family practitioner in Northville and the chief executive and medical director of Olympia Medical Services, a Livonia-based physicians group.

“The issue for doctors is, how aggressive are you willing to be to go after that payment and are you going to be available to send that money back if they pay the premium in full?” Bickle said, describing some of the questions that have popped up since this quirk was discovered.

The Michigan State Medical Society, which represents 15,000 doctors, has been educating its members about the rule as well, said Rebecca Black, the society’s senior director of health care delivery and education.

“Physicians are so overwhelmed right now because there are so many mandates that they are supposed to be a part of or they will start to get penalized,” Black said. “Because they have so much going on, it’s a good time to remind our membership to check insurance eligibility with every office visit.”

One of those overwhelmed is Dr. Annemarie Poleck, who practices family medicine solo in the office her father, Dr. Stanley Poleck, founded in Detroit. While her staff checks the eligibility prior to each appointment, often an insurance company fails to have the most current information, giving her a green light to treat, rather than a red.

Poleck is already seeing signs of the impact of this 90-day grace period. Recently, she referred a patient to a podiatrist for a broken ankle. Two podiatrists, leery of the patient’s marketplace health care, refused to see her unless she paid in advance for their service that she would receive in the future. A third podiatrist finally agreed without the upfront payment stipulation.

“I expect a lot of doctors will refuse to see patients in the future because they are worried about payment, and that goes against our training,” Poleck said.

Dr. Robert Frank, chief executive and chief medical officer of Wayne State University Physician Group in Detroit, doesn’t expect that to happen with the 2,000 doctors in his physician group, the second-largest in southeast Michigan.

“The physician-patient relationship is a very different relationship than repossessing someone’s car,” Frank said.

“It’s always been treated with reverence, so I think people are somewhat reluctant to collect from a patient, but it has become a factor of everyday business. With a group like ours, which has a good technology backstop, I expect we will be able to check patients’ insurance in real time, so I don’t believe it will be a significant problem.”

Wayne State University Physician Group, long a presence in the Detroit Medical Center, is undergoing a suburban expansion. It’s opening two floors of clinical and physician offices in June at the former Saturn headquarters in Troy, where its “back office” crew is already located, including the billing department.

Despite the extra offices, Frank believes current billing staffing will easily handle all of the new rules, so there are no plans to increase its staff.

“I don’t foresee in the short run this rule impacting us on any level,” said Frank, whose group provides more than $9 million annually in charity care.

The charity question is one that Henry Ford Health System is exploring, said Sharifa Alcendor, director of patient care management and assistance for Henry Ford. “It would actually cost us a lot less money if we just pay a person’s $125 insurance premium for them rather than foot the $125,000 care they’ve needed, so we’re busy researching and looking for guidance if its legal and appropriate to help patients” by paying their premiums when they encounter this quirk, she said.

Beaumont Health System will follow the CMS rule but remains unsure of its impact.

“We have no way of predicting how many such patients will come to Beaumont (or Beaumont doctors), and whether or not they will keep up on their premiums,” said Doug Darland, vice president, contracting and payer strategy for Beaumont. “The impact could be very small or very large, based on the types of services provided.”

Blue Cross Blue Shield of Michigan has put several programs in place to minimize the impact of this government mandate, which may be avoided by a patient if he or she pays the insurance premium on time, said Terry Burke, Blue Cross vice president for individual business.

Blue Cross extended its initial deadline for a first payment to 30 days rather than the marketplace’s 10 days and later pushed it back another 30 days, Burke said. New members received a welcome call from a new team of representatives who remind them that coverage begins when they receive payment.

Then Burke followed up with an automated telephone reminder and a letter to reinforce the message.

The results of this forethought helped Blue Cross achieve a 97 percent premium payment rate.

“We are all trying to do the right thing” in helping prevent billing surprises, Burke said.

From The Detroit News: http://www.detroitnews.com/article/20140517/BIZ/305170024#ixzz32M2CNmwC