Introduction
Medical insurance coverage is directly related to the amount of billing activity done by a practice. The better the coverage the more likely patients come and the more you can bill. There have been many changes to the insurance law in the last year and several regulations are set to be in effect in the years to come. Some of these are on off-shoot of the Affordable Care Act signed into law by President Obama. In this article, I will describe some of these changes and how it may affect your practice.
Examples of insurance law changes due to healthcare reform
For those who already have health insurance:
•Insurers will not be allowed to take away your coverage if you get sick-effective 2010
•Insurers will not be allowed to limit how much they will pay for medical benefits over your lifetime – effective 2010
•Policies will now have to pay for tests to detect chronic diseases (ie. cancer) at earlier stages but not require any deductibles, co-pays or co-insurances -effective 2010
•Insurers will not be allowed to limit how much they will pay for medical benefits during a year-effective 2014
For those who can’t afford insurance or have trouble finding coverage for 1 or more persons:
•Your children may be on your policy or be added to your family policy until they turn 26-effective Sept 2010
•Temporary coverage to those with pre-existing conditions till health insurance exchanges are set up (in 2014)- effective Sept 2010
•Insurers can no longer charge you excessively more because of past medical history age or sex. But, they can charge up to 50% more if you smoke –effective 2014
•The HIEs will be set-up for those who can’t get insurance through work or lost their job. -effective 2014. (Those who qualify for one and don’t sign up will be penalized)
What does this mean to you?
If you are a small practice, particularly in primary care, these changes may provide you increased financial viability as more people likely will seek medical care. Small practices often don’t get as much reimbursement as a larger practice for the level of work and need to make the make up the different by seeing more patients. Also, if you serve an area with a lot of uninsured patients, then you may be able to accept them soon, as nearly everyone will have health insurance by 2014. Oftentimes, patients may hesitate to seek medical care because of all the limitations on what is covered as dictated by their insurance policy. But, with changes such as no limits of benefits over a lifetime or year, coverage of illnesses excluded by pre-existing condition clauses, etc. more patients will be able to get their treatment paid for.
Conclusion
It is that apparent that there are major changes to insurance coverage as result of healthcare reform. However, if you ask Dr. Chawla this is a crucial trial period. This is just the beginning and there are many more changes expected to come over the years. Those having insurance and not having insurance are the 2 categories used as examples. But, the insurance law changes also affect people on Medicare exclusively, in long term care and small business owners. As patient volume increases, logically it becomes more and more important to have a very efficient, structured billing process in place.
What do you think about this topic? Do you think these changes will affect you? We would love to hear from you.
Medical insurance coverage is directly related to the amount of billing activity done by a practice. The better the coverage the more likely patients come and the more you can bill. There have been many changes to the insurance law in the last year and several regulations are set to be in effect in the years to come. Some of these are on off-shoot of the Affordable Care Act signed into law by President Obama. In this article, I will describe some of these changes and how it may affect your practice.
Examples of insurance law changes due to healthcare reform
For those who already have health insurance:
•Insurers will not be allowed to take away your coverage if you get sick-effective 2010
•Insurers will not be allowed to limit how much they will pay for medical benefits over your lifetime – effective 2010
•Policies will now have to pay for tests to detect chronic diseases (ie. cancer) at earlier stages but not require any deductibles, co-pays or co-insurances -effective 2010
•Insurers will not be allowed to limit how much they will pay for medical benefits during a year-effective 2014
For those who can’t afford insurance or have trouble finding coverage for 1 or more persons:
•Your children may be on your policy or be added to your family policy until they turn 26-effective Sept 2010
•Temporary coverage to those with pre-existing conditions till health insurance exchanges are set up (in 2014)- effective Sept 2010
•Insurers can no longer charge you excessively more because of past medical history age or sex. But, they can charge up to 50% more if you smoke –effective 2014
•The HIEs will be set-up for those who can’t get insurance through work or lost their job. -effective 2014. (Those who qualify for one and don’t sign up will be penalized)
What does this mean to you?
If you are a small practice, particularly in primary care, these changes may provide you increased financial viability as more people likely will seek medical care. Small practices often don’t get as much reimbursement as a larger practice for the level of work and need to make the make up the different by seeing more patients. Also, if you serve an area with a lot of uninsured patients, then you may be able to accept them soon, as nearly everyone will have health insurance by 2014. Oftentimes, patients may hesitate to seek medical care because of all the limitations on what is covered as dictated by their insurance policy. But, with changes such as no limits of benefits over a lifetime or year, coverage of illnesses excluded by pre-existing condition clauses, etc. more patients will be able to get their treatment paid for.
Conclusion
It is that apparent that there are major changes to insurance coverage as result of healthcare reform. However, if you ask Dr. Chawla this is a crucial trial period. This is just the beginning and there are many more changes expected to come over the years. Those having insurance and not having insurance are the 2 categories used as examples. But, the insurance law changes also affect people on Medicare exclusively, in long term care and small business owners. As patient volume increases, logically it becomes more and more important to have a very efficient, structured billing process in place.
What do you think about this topic? Do you think these changes will affect you? We would love to hear from you.
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