Second Open Enrollment Begins, How Will the Changes Affect Your Medical Billing?

by | Last updated Dec 9, 2023 | Published on Dec 8, 2014 | Medical Billing

Open Enrollment
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The second Open Enrollment for Obamacare plans comes with a lot of changes from the first enrollment, which would require healthcare providers to improve their billing procedures and systems a little more. The enrollment started on November 15 and will end on February 15. Those who want their coverage beginning on January 1, 2015 should enroll by December 15. For the 2015 plan year, 27 federally facilitated Marketplace states, 7 state partnership Marketplaces, and 3 state based Marketplaces will use the federal site.

The other major changes with the second enrollment are as follows.

  • Additional Insurers – The number of insurance companies that offer Marketplace coverage will increase in 2015 for 35 states though the number will decline in two states.
  • Changes in Premium and Tax Credit – As per a preliminary analysis of premiums in 16 cities, the premium for the second lowest cost silver plan (the benchmark plan used for computing premium tax credit amounts) will drop by 0.8 percent on an average rate. Meanwhile, the benchmark premium among those cities will increase by as much as 8.7% and drop by as much as 15.6%. These changes will have an effect on the coverage cost for those consumers eligible for premium tax credits even if their own circumstances don’t change from 2014 to 2015. However, the cost of coverage will get affected by changes in an individual’s income, age, family status and the formula used for calculating premium tax credit eligibility.
  • Changes in Cost Sharing – The maximum out-of-pocket (deductibles, co-pays and coinsurance) cap amount for 2015 will be increased to $6,600 for an individual and $13,200 for a family policy compared to $6,350 and $12,700 respectively in 2014.
  • Changes in Individual Responsibility – For 2014, the tax penalty for not getting insured into a healthcare plan is $95 per adult or 1% of household income over the tax filing threshold. It will be increased to $325 per adult or 2% of household income over the tax filing threshold in 2015.
  • Medicaid Changes – Pennsylvania will adopt expanded Medicaid eligibility for adults from 2015, which will increase the number of expansion states to 28. The states that have not yet adopted the expansion may decide to expand Medicaid eligibility at any time in 2015.

Consumers who enroll into a Marketplace plan during the second enrollment period will be affected by these changes. Healthcare providers should thoroughly consider these changes when billing for services provided to the patients enrolled through Marketplace under ACA.

Let’s see how healthcare providers are affected by these changes and what preparation steps they should take.

  • We have already seen the out-of-pocket cap amount will be increased in 2015 and so healthcare providers should establish effective mechanisms to collect from patients up-front to ensure better revenue from Marketplace plans. Providers can offer some level of financial counseling as well as payment plans for patients. However, the most important thing is to have billing experts, right procedures and effective tools in place.
  • It is very important to perform patient eligibility verification before providing services. Since the requirements for 2015 plans will be different, healthcare facilities can surely benefit from the expert support of a medical billing company, which has a thorough understanding of the rules and requirements of the plans offered under ACA.

In short, the healthcare providers should either thoroughly train their staffs on the requirements of ACA or purchase an entirely new patient intake and billing system that supports billing requirements under the ACA. A more cost-effective and viable solution is to outsource billing procedures to a reliable medical billing and coding firm that keeps abreast of current developments in the healthcare field. With a reliable outsourcing partner, physicians and office staff need not spend their valuable time striving to accommodate the new changes, and can instead dedicate their time to providing quality care.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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