Survey: Most Physicians not in Favor of Affordable Care Act Repeal

Survey: Most Physicians not in Favor of Affordable Care Act Repeal

Health insurance plays a key role in how physicians get paid for their services. Most medical practices have an insurance verification specialist check out patients’ coverage before the office visit. This provides a clear picture about what the insurance company will pay and patients’ financial responsibilities. But now, physicians are worried about how the plans to repeal the Affordable Care Act (ACA), will affect their ability to provide treatment as well as their income.

Under the ACA introduced by former U.S. President Barack Obama, individual health insurance plans assured coverage regardless of the individual’s preexisting conditions or health problems. With the new U.S. Republican Government pressing for the scrapping of the Affordable Care Act, recent reports indicate that physicians and hospitals are very concerned about how healthcare will be delivered and funded.

According to a Hartford Courant report, the Connecticut Hospital Association said that if the law is repealed and the cuts to Medicare continue, hospitals’ fiscal stability and sustainability, as well as patient access to care, will be significantly compromised. If patients lose coverage, it will be more difficult for physicians to continue providing care. If people with chronic issues lose coverage or do not get regular treatment, their diseases can become both risky and expensive. This is the most important concern among physicians.

Forbes reports that a recent poll of 426 physicians by the Johns Hopkins University School of Medicine shows that the majority do not favor Obamacare repeal. The survey found that:

  • Only 15% of the physicians who responded want Obamacare repealed
  • 95% of the physicians support the ACA’s requirement that health coverage cannot be denied to an individual who has a pre-existing condition
  • 38% who voted for Trump and 32% who supported the Republican party support the repeal
  • 91% support tax credits offered to small businesses that assist in offering insurance to employees
  • 88% back the ACA’s provision that allows young adults up to the age of 26 to remain on their family’s insurance plan
  • 75% of physicians support subsidies offered to individuals to make health insurance more affordable
  • 73% expressed support for expanding Medicaid for those who earn up to 138% of the US poverty level
  • Only 50% of physicians support the ACA’s individual mandate that requires individuals to pay a fine if they do not have insurance

Meanwhile, open Enrollment in 2017 is still on and GOP leaders in Congress are delaying plans to repeal the ACA till they can come up with a practical alternative.

Regardless of the outcome of these developments, reliable medical billing companies will continue to support physicians in their efforts to maintain financial stability while providing quality care.

Obamacare 2017 – Is Your Medical Practice Ready for the Changes?

Obamacare 2017 – Is Your Medical Practice Ready for the Changes?

For medical practices, insurance verification means knowing about their patients’ coverage in order to be able to bill for the services provided to them. For consumers, the current concern is how much they will have to pay as insurance premiums under Obamacare to keep their coverage active and get the healthcare services they need.

According to recent reports, consumers will see many changes in Obamacare. As Americans begin to enroll in or change 2017 marketplace health insurance on Nov 1, they will face higher premiums but fewer choices as insurers are backing out of several states. Medical practices need to be aware of these changes which will impact their patients and their bottom line.

CNN Money reports that the effect of an average 22% rise in benchmark plan prices will vary by state – from modest increases to severe hikes. The key changes that the health insurance scenario will witness are as follows:

  • Premiums have increased by an average of 25 percent in the 39 states using the federally run insurance exchange.
  • Obamacare prices have risen by 40% or more in 10 states: Alabama (58%), Alaska (29%), Arizona (116%), Illinois (43%), Kansas (42%), Montana (44%), North Carolina (40%), Nebraska (51%), Oklahoma (69%), Pennsylvania (53%), and Tennessee (63%). In Minnesota, which runs its own health exchange, premiums will increase by 56%.
  • Up to 33 states will have fewer insurers in 2017 than they had in 2016.
    Arizona and Texas have lost six insurers, while Kentucky and Ohio have lost four each. Alabama, Alaska, Oklahoma, South Carolina, and Wyoming – will have only one insurer offering exchange coverage in 2017.
  • Customers in 68.7 percent of U.S. counties will have only one or two insurers. Alabama, Oklahoma, and three other states will only one insurer.

Reports say that 85 percent of Obamacare enrollees receive taxpayer-funded subsidies for their coverage and therefore will not be hit by the full price hike. Enrollees can use their subsidies to buy lower – priced bronze or silver plans and choose one for $100 or less a month on the federal exchange. However, according to a report published by The Daily Signal, of the 17.7 million Americans who had coverage in 2015, up to 10.3 million (58 percent) paid the full cost on their own.

It’s a fact that Obamacare has increased health insurance coverage across the nation. Statistics from the Centers for Disease Control and Prevention show that the share of people without health insurance has come down from 18% in 2010 to 10% in 2016. Nevertheless, a recent survey by Kaiser Health shows that, in 2017, there is still considerable scope for increasing coverage among children and the low – income population – groups that qualify for the greatest assistance under the Affordable Care Act (ACA).

How has Obamacare impacted medical practices? How will the current changes affect them? Reports say that with the ACA, physicians face additional burdens such as: reduced incentive payments, Medicaid expansion and tighter payments, bundled payments and reimbursements based on metrics. Moreover, they have to deal with new regulatory reporting, disclosure and compliance requirements. Under Obamacare, patient benefit verification has also become a major challenge for physicians’ offices. The staff has to spend a long time on the phone verifying patients’ coverage and making sure that their coverage is active. The impending changes in enrollee coverage and services can make things even more cumbersome.

Many physicians can adapt more easily to these developments, manage their new workload, and reduce risks of no – payments by outsourcing medical billing and insurance eligibility verification to companies that specialize in these tasks.

Obamacare under a Cloud as Top Carriers Back Out

Obamacare under a Cloud as Top Carriers Back Out

With top health insurers pulling out of the health exchanges due to heavy losses, Obamacare is under a cloud. According to a CNN report, Aetna will exit from 11 of the 15 states where it offers Obamacare policies, UnitedHealthcare will continue in only three states in 2017, and Humana (HUM) will withdraw from nearly 1,200 counties in eight states. With enrollment for 2017 scheduled to start soon, experts are speculating on the possible implications of these high-profile insurers’ actions on patients and physicians.

The idea behind the state-based exchanges or marketplaces was to make insurers compete directly with each other for patients by offering them comparable insurance coverage. It was expected that this would make the exchanges a reliable source of coverage for millions of people with a larger number of plan choices.

Six years into the passing of the Affordable Care Act (ACA), top insurers are exiting Obamacare and the primary reason is cost. According to McKinsey’s Center for U.S. Health System Reform, insurers’ costs exceeded income by 5% in 2014, and the figure doubled in 2015. Their losses are expected to increase this year too. The reasons for the rising costs are as follows:

  • Under health care law, insurers cannot deny coverage for people with pre-existing conditions, and must offer a range of benefits. To balance this, they raised premiums for younger, healthier people, who in turn opted out and chose to pay a fine for not having insurance rather than a premium.
  • Enrollment rates of more expensive, traditionally uninsured Americans have increased, resulting in heavy losses for insurers focused on the employer market.
  • Insurers have said that they are finding it difficult to fix prices for plans when the government allows people to enroll outside of a specific timeframe.

CNN reports that insurers who offer more restrictive policies targeting lower-income customers who qualify for both premium and out-of-pocket subsidies have performed better on the exchanges. These companies have only a limited network of doctors and hospitals.

Patients will also bear the brunt of the insurer pullout from their state health exchange. They risk losing their preferred doctors and hospitals if they enroll in plans that do not include these providers. Those in rural areas will be affected the most.

Experts have gauged the impact of insurers’ exit from the health exchange on physicians’ practices and hospitals. With less competition, the remaining companies could reduce reimbursements to physicians, according to a recent Pacific Research Institute report. The Department of Justice (DOJ) has blocked previous health plan mergers because of the harm they could cause to physician practices. In any case, these developments indicate that physicians should pay more attention to revenue cycle management.

One of the main concerns raised by insurers is about Obamacare’s risk adjustment program under which customers in good health are made to fund Medicare enrollees diagnosed with chronic costly conditions such as diabetes and HIV. To help Medicare Advantage plan providers meet their responsibilities, physicians’ practices maintain documentation with accurate ICD-10 coding and report claims in a timely manner. RADV audits help carriers determine if the diagnosis codes submitted can be validated by medical record documentation. Insurers now want utilization of expensive specialty drugs to be included in the risk adjustment formula. The Department of Health & Human Services is starting to make changes in this regard with the hope of attracting insurers back into Obamacare.

What You Should Know About Enrollment in Obamacare

What You Should Know About Enrollment in Obamacare

Obamacare rolled out on January 1, 2014 and for those who enrolled in a health plan on December 24, 2013 via a federal or state health insurance exchange, coverage began on January 1, 2014. It’s important to know the facts. Many young adults are putting off buying health insurance through the exchange and think they would be better off paying the penalty of $95 a year or 1% of their income (whichever is higher). With plans on state-based exchanges costing as much as $200 to $300, young people also feel that it would be better to sign up for Obamacare only when they have a serious health issue or an accident. But there’s more to it. Here are some important things you should know about enrollment in Obamacare.

Americans can sign up for an Obamacare health care plan on the exchange during a specific enrollment period, which for 2014, ends on March 31, 2014. That means even if you have not signed up so far, you still have time to do so till March 31, 2014. However, if you miss the March 31 deadline, you cannot purchase health insurance through a federal or state exchange in 2014 and receive the federal subsidy or tax credit.

If you do not enroll in Obamacare by March 31, 2014, you can still get coverage by buying a health plan outside the exchange at any time (though you should check with the plan for actual date on which you can enroll). These policies, sold by private health insurance companies, will cover many of the benefits offered by the plans sold on the exchanges, such as maternity and mental health benefits, and cannot exclude people with pre-existing conditions.

However, those who opt to purchase insurance off the exchange will face the challenge of comparing plans and premiums. The Obamacare health exchange websites allow people to browse through the various plans offered and choose the one that best suits their needs and budget.

People who still want to sign up for Obamacare plan after March 31, 2014 can do so during the enrollment period that runs from October 15 to December 7, 2014. Coverage will begin only in 2015.

Exceptions to the Rule

There are special enrollment periods for people with ‘qualifying life events’. This means you can enroll in Obamacare at any time outside the open enrollment period if you are experiencing a major life event: getting married, having, adopting, or placement of a child, permanently moving to a new area that offers different health plan options, losing other health coverage due to a job loss, and so on. Also, Americans who are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) can enroll at any time this year.

Sign Up without Delay

If you have decided to purchase coverage through the health exchange, you should do so at the earliest and not wait till you fall sick or have an accident. If you sign up between the 1st and 15th day of the month and pay your premium on time, your coverage will start on the first day of the following month and your illness or accident would not be covered. Emergency room bills can run into thousands of dollars, prompting the government to look for ways to standardize ER charges for tighter control over ER medical billing practices. Having a plan that covers emergency care can give you peace of mind.

More Young Adults Enrolling into Obamacare Allays Premium Rise Concerns

More Young Adults Enrolling into Obamacare Allays Premium Rise Concerns

More young people are enrolling in Obamacare. According to a recent report, the Department of Health and Human Services (HHS) compared the proportion of young enrollees to enrollment data for 2014. It was found that in mid-January last year, 29% of enrollees were under the age of 34 and that this year, this number has risen slightly – people under the age of 34 made up 33% of those who chose a new plan. It is expected that the number of young enrollees will rise by February 15th, 2015, the date which marks the end of Open Enrollment.

In May 2014, HHS reported a surge of young adults (in the age group 18-34) in Health Insurance Marketplace enrollment, which helped Obamacare sign-ups to move beyond the target. The report said that 2.2 million (28 percent) of young adults among eight million selected a marketplace at the end of the first enrollment period that spanned from October 1 to March 31, 2013 while 1.2 million young adults among 3.8 million enrolled in the sixth and final reporting period that began on March 2 and ended on April 19, 2014 pushing the enrollment beyond the target. This is a good sign as there were concerns regarding the viability of Obamacare if mostly sick or elderly people signed up for the marketplace plans.

As per the New York Times report, the President also said that enrollment for health insurance under the Affordable Care Act surpassed the goal and the role of young adults is quite evident. During the early months of enrollment, the number of young people in the age group 18 – 34 and who tend to be healthier who were signing up amounted to only 25%. The number increased at the last minute enrollment as expected by the White House officials. Those who had started the enrollment process, but not completed were given grace period after the March 31 deadline. White House officials opined that the high enrollment rate of young people is likely to keep premiums lower compared to what they would have been otherwise.

So, how does the enrollment of more young adults result in lower premiums? For every older enrollee, a group of young people is required to cover the costs as the older people can’t be charged more for their care as per the Affordable Care Act. Young enrollees effectively subsidize the older enrollees in the 50 to 64 age band who are less healthy than the younger group. If enough healthy people are not signing up, insurance companies will have mostly high-cost consumers on their plans and they will be left with no other option but to increase the premium cost. No doubt, this will drastically affect the long-term viability of Obamacare.

A 2013 Bloomberg report draws attention to a survey conducted by Morning Consult (a Washington-based media company), which revealed that around 56 percent of young people in the age group 18 to 29 support Obamacare. The report lists mainly two reasons for this support.

  • Federal Subsidies – People who earn up to 400% (up to $45,960 for an individual and $94,200 for a family of four) of the poverty line are eligible for subsidy in premium cost while those who earn less than 250% of the poverty line ($28,725 for a single person and $58,875 for a family of four) are eligible for extra subsidies in out-of-pocket costs such as deductibles and co-payments. However, the actual amount of subsidy depends upon the income, age and location of the enrollee.
  • Handling Emergency Situations – Though younger people rarely use insurance, they may end up paying a larger sum in case of unpredictable healthcare needs (for example, accident) if left uninsured. Marketplace plans are really helpful to handle this kind of emergency situations since they cover a set of health benefits known as ‘essential health benefits’ which include ten categories of healthcare service. This set comprises mental health and brand-name drugs or pre-natal care which is not typically covered by private plans outside the healthcare exchanges.

However, the overall percentage of young people enrolled does not guarantee that the Obamacare program will work perfectly in all the insurance marketplaces across the country. Each state needs to be considered separately as the insurance is pooled at the state level.

In order to receive proper reimbursement, physician practices should verify the insurance details of their patients enrolled into Obamacare plans before scheduling an appointment to know whether they are eligible for federal subsidies. Since verifying each patient’s insurance details with the insurer will be a tedious task for physicians, they can seek the support of a professional medical billing and coding company that offers insurance verification services. They can streamline their billing process effectively with the help of experienced billing and coding professionals in the company.

Many Uninsured Uninformed About Obamacare Open Enrollment Period

Many Uninsured Uninformed About Obamacare Open Enrollment Period

With the open enrollment for health insurance coverage beginning on November 15, the Obama administration has long been involved in field testing the website to avoid the technical hiccups that occurred last year. However, the biggest challenge for officials may not be making the website work, but getting maximum number of customers to shop in the first place. Even though the Obama administration is attempting to nearly double the number of people registered and is expecting a better sign-up experience for the ACA plans during the second annual enrollment period in November – the question that remains is how many uninsured Americans know about the open enrollment deadline?

According to a new Kaiser Health Tracking Poll, about nine out of 10 (that is 89 percent) uninsured people are quite unaware of the fact that open enrollment begins in November or any time soon. This shocking figure includes 76% people who do not know when open enrollment begins and another 13% who name a start date other than November 2014.

As per reports from The New York Times, despite huge efforts by the government and insurance industry to publicize this important deadline, about two-thirds of uninsured survey respondents revealed that they knew “only a little” or “nothing at all” about the Obamacare insurance exchanges where they can purchase health benefit plans with the help of federal subsidies.

Experts Hope the Number of New Enrollees Will Increase

The officials in the healthcare domain feel that “Having just no specific idea about enrollment deadline is quite shocking at this point because unlike last year, the shopping period for marketplace plans is just 3 months”. Therefore new enrollees who plan to buy policies need to sign up for their plans between November 15 and February 15 or else they will have to wait for another one year. The experts in this field anticipate that this number will increase considerably as we get closer to the open enrollment date.

Under the ACA, most Americans are required to obtain medical insurance or else pay a fine. Despite countless technical problems, more than 8 million people succeeded in choosing medical plans on the new website last year. As per the latest count from the Department of Health and Human Services (HHS), approximately 7.3 million people are currently enrolled and it is estimated that about 13 million people will be fully covered by the end of this enrollment date. This huge number of enrollees will make an equally huge impact on healthcare providers, increasing their responsibilities towards patients as well as their office processes such as medical billing for services provided. It also calls for a more stringent insurance verification process to ensure that patients indeed have coverage for the services provided.

Americans with low income (about $27,000 for a family of three) who happen to qualify for Medicaid can sign up for health plans at any time. On the other hand, the open enrollment is applicable to everyone else who doesn’t experience a major life change (like losing job or getting divorced) during the year. In order to sign up for the same it is important that eligible people know that these options are available.

As part of the survey, information was collected from about 1,503 adults between October 8-14. The key findings of the survey include –

  • About half of people are unaware about the financial assistance available to help low and moderate income people to purchase insurance.
  • About 56% Americans said that the health law did not create any direct impact on their families. On the other hand, out of those people who had been reported impacted – 26% say that the law has hurt them and 16% say that it has helped them.
  • For the uninsured group, nearly half of them had no insurance for about 2 years.
  • About 18% of people choose to remain uninsured as they were not able to find a suitable and affordable plan. More than 12% say that they will buy insurance as they don’t want to be forced to buy anything (including 3% who declare that they would rather pay the fine than pay for coverage).

Spreading Awareness about Health Benefit Plans is Crucial

For the healthcare exchanges to function well, it is crucial for people (many of them with only a high-school education) to have excellent technical know-how about the different healthcare plans and choose individual plans diligently. Before choosing any specific plan, it is essential to compare premiums, drug plans, networks and cost sharing of dozens of different policies every year. This will in turn lower the risk of making bad purchases.

However, experts in this field who evaluated the uninsured group found that the first wave of enrollees were probably the most aware and responsive group in the United States. Spreading more awareness among the uninsured group remains a big challenge as many of them have remained without any insurance for long and have only vague knowledge and understanding about the healthcare system. In fact, many people did not even speak English as their first language. Those who remain without coverage are fundamentally harder to reach than those who enrolled in the first enrollment period. But this doesn’t necessarily imply that they cannot be convinced at all. Those people who remain uninsured will certainly recognize the need and benefits of coverage once they fully understand how Obamacare works in the real sense.