What Docs Need to Know About the ACA Coverage Grace Period
The American Medical Association has new guidance documents to walk physician practices through the Affordable Care Acts insurance coverage grace period before a policy is cancelled for lack of payment.
The American Medical Association has new guidance documents to walk physician practices through the Affordable Care Acts insurance coverage grace period before a policy is cancelled for lack of payment.
If individuals buy health coverage on a state insurance exchange but then dont make payments, physicians could be out money. The AMA notes that the Centers for Medicare and Medicaid Services published a little known rule that gives individual purchasers of subsidized coverage through state exchanges a 90-day grace period before coverage is cancelled for non-payment.
But its not a real grace period. Under the CMS rule, insurers in health exchanges are required to pay any claims incurred during the first 30 days of the grace period, but insurers are not required to pay claims incurred during the last 60 days for any patient whose coverage is terminated, according to the AMA. Patients are considered to be covered for care during the entire grace period, but insurers are allowed to place all the claims during the last two-thirds of the period in a pending status and retroactively deny them when coverage is terminated at the end of the grace period.
Consequently, the AMA has four new guidance documents: a step-by-step guide to the ACA grace period, a grace period collections policy checklist, model financial agreement language for patients receiving advance premium tax credits, and a sample letter to patients after insurers have notified physicians of those who havent paid the premiums.
In addition, many of the nations physician associations and societies have sent a letter to CMS Administrator Marilyn Tavenner asking for changes in the grace period policy.
If individuals buy health coverage on a state insurance exchange but then dont make payments, physicians could be out money. The AMA notes that the Centers for Medicare and Medicaid Services published a little known rule that gives individual purchasers of subsidized coverage through state exchanges a 90-day grace period before coverage is cancelled for non-payment.
But its not a real grace period. Under the CMS rule, insurers in health exchanges are required to pay any claims incurred during the first 30 days of the grace period, but insurers are not required to pay claims incurred during the last 60 days for any patient whose coverage is terminated, according to the AMA. Patients are considered to be covered for care during the entire grace period, but insurers are allowed to place all the claims during the last two-thirds of the period in a pending status and retroactively deny them when coverage is terminated at the end of the grace period.
Consequently, the AMA has four new guidance documents: a step-by-step guide to the ACA grace period, a grace period collections policy checklist, model financial agreement language for patients receiving advance premium tax credits, and a sample letter to patients after insurers have notified physicians of those who havent paid the premiums.
In addition, many of the nations physician associations and societies have sent a letter to CMS Administrator Marilyn Tavenner asking for changes in the grace period policy.
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