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Affordable Care Act Provisions and Protections Are At RISK!

3rd Party Billing and Collections
in 3rd Party Billing and Collections

Affordable Care Act Provisions and Protections Are At RISK!

Affordable Care Act Provisions and Protections Are At RISK!

The night before the December 15th deadline to enroll in marketplace health plans, a Texas Federal judge ruled the Affordable Care Act (ACA) as unconstitutional. The timing of the ruling caused consumers to flood the customer service department with inquiries; which caused many enrollments to be delayed by several days, in some cases. The wave of concern and confusion was felt as far as Wall Street when stocks dropped.

What does all of this mean for providers?

For now, nothing has changed, as this case is currently in appeals. What could it mean in the near future? If the ruling is accepted, then everything related to the ACA would be done away with, which means many of the protections would no longer exist for your patients.

What steps should you take now?

Stay informed! At KMC University we will continue to keep our ear to the ground. We encourage you to focus on strengthening your process for verifying benefits within the clinic. If you do not have a process in place, take advantage of the resources available for KMC University Library members. This announcement happened overnight. The final decision can be just the same, so you need to be prepared to ask the right questions when verifying benefits. It is important to note that pre-existing conditions is not the only thing at stake. The ACA also protects your reimbursement through the provisions outlined in Section 2706 (non-discrimination provision).

The American Chiropractic Association stated the following, It is the ACA’s view that Section 2706 applies in the following situations, however this is not an all-inclusive list:

  • if there is evidence that Doctor of Chiropractic are being reimbursed at a different level than other providers for the same covered service and such discrimination is not based on quality or performance measures, but is based in whole or in part upon licensure,
  • if there is evidence that an insurer or group health plan is, for example, applying caps on specific services provided by Doctor of Chiropractic, and such caps are not being applied to other providers based in whole or in part upon licensure, and/or
  • if there is evidence that the insurer or group health plan is denying specific forms of care otherwise covered under the plan on the basis that it is provided by a Doctor of Chiropractic, and the covered service is within the scope of practice of a doctor of chiropractic;

A payer can by their actions or policies discriminate against doctors of chiropractic through covered services and exclusions. Section 2706 provides protection and as a result, payers have had to process claims by procedure code rather than provider type. You can read more about Section 2706 HERE.

So, there is much more to lose than just protection from pre-existing conditions. We encourage you to locate your current payer contracts, register for payer portals (if you have not already) and ready your clinic for what may become the biggest shift in healthcare coverage since March 2010. The past has shown, those clinics with a solid verification process and clear understanding of payer policies often weather the ‘storm of change’ perfectly. Feel free to read more about the Federal judge ruling HERE.