Optometric Billing-Keeping It Legal After ObamaCare-The Affordable Care Act

Good Morning,

As exchange plans continue limiting provider networks and ramp down compensation, it’s not surprising that more professionals are exploring or pursuing different options. Some physicians are conducting a concierge or retainer practice that offers upgrades to cash-paying patients. Some have decided to “opt out” completely of insurance programs. Others, who continue to participate in governmental and managed care arrangements, however are considering whether going “out of network” makes more sense financially and operationally, than remaining network providers.

The Affordable Care Act has imposed new requirements that impact the ability to accept and charge patients for concierge (retainer) service, even if they are participating in exchange plans, or in Medicare and traditional commercial plans. The law also requires every citizen to obtain insurance, meaning that many “cash” patients will in the future be covered.

Providers who seek to “opt out” have to follow a set of procedures to extricate themselves from Medicare or managed care plans. They will need to enter into agreements with Medicare patients regarding future care. Further, payer requirements and state laws also impose limits on doctors or groups establishing a cash or a concierge practice.

Join us for this Live Audio Conference - "Concierge Practice: How To Keep It Legal Post Affordable care Act" on Thu, Jan 16, 2014 at 1 pm ET | 12 pm CT | 11 am MT | 10 am PT where expert speaker Wayne J. Miller, Esq. will discuss the current limitations on a concierge practice and how it may still be viable in the new environment.


Highlights of the session:

• What requirements do exchanges impose on providers?
• Definition of services that are “covered” in exchange and other plans as per ACA
• Private vs. public exchanges: what providers need to know
• Must you serve exchange patients under existing contracts?
• Terms to look for in new deals to serve exchange patients
• Reducing liability risk for nonpayment
• Due diligence steps recommended before taking on exchange business

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

If interested, please click the following link to register and get your early bird discount:-

CLICK HERE TO REGISTER

Please apply discount code "SAVE20" at checkout to get an additional $20 discount on registration.

Looking forward to your participation here.

Thanks,
Jennifer Smith

Optometric Billing-What "ObamaCare" Means to Your Pracitce

It's now January 15 and pretty soon, if not already, patients are going to start walking through your door who got their health insurance through healthcare.gov. Many of these patients will be younger, as those with good jobs at firms with greater than 50 employees will retain the insurance they've already had. Also, ObamaCare does not generally affect the elderly or those that already have been on Medicare and Medicaid (although it will most likely affect any medicare plans or supplement plans they purchase privately). So, it can be safe to assume that the majority of your new ObamaCare patients will be younger, healthier individuals who have their own insurance for the first time or new Medicaid patients that qualify for this government program now where they may not have a year ago. So, what does this mean to you?

ObamaCare is not cut and dry. The influx, if you want to call it that, of new patients to your office is not going to be what you may have thought or hoped it would be. At its easiest explanation, you're going to be billing patients for more deductibles and out of pocket expenses. This is because the average person is going to have an annual deductible of at least $2,000.00. (This is going to spill over into employer sponsored plans as well as employers will begin giving similar plans to their employees in an effort to cut the increased costs that will be associated with ObamaCare)

Next, patients with Medicaid are going to start coming to you with vision riders like VSP, such as has happened in California over the past year. This may represent either in increase in your base pay for routine service or a decrease depending on the policies that were in place at your local Medicaid office. If this scenario were to play out here in Vermont, and it's looking like a very strong possibility, we would actually receive about 40% less for each Medicaid routine eye exam we perform...OUCH!

Another issue you may face is that it is beginning to progress to the point where optometrists are going to become primary care providers for patients with certain illnesses; the most likely one is Diabetes. Here in Vermont, to give an example again, we are part of an information exchange known as NNEAC. This exchange tracks our patients and requires us to maintain in contact with certain patients THEY deem we should be responsible for helping co-ordinate care with and awards us quality points as a result. This system is extremely convoluted and even after spending hours on the phone with various representatives at NNEAC I still don't get it. In fact, I got a welcome email from them today telling me my account had been activated and I have decided to ignore it until I have time to wrap my mind around the whole thing...again.

Here's another development that may take place in your state that is beginning to take shape here in Vermont already. Your state may decide that they want to provide a single payer system for its residents. In our case here, that payer has been deemed Medicaid. To us, and this is totally an educated guess, this means that when the single payer system takes over, presumably in 2017 as originally estimated, every one of our patients will either be Medicare or Medicaid. This means that our recall numbers are likely to decline because our Medicaid only pays for 1 routine eye exam every 2 calender years unless the patient is under the age of 12...again, OUCH! Also, it will be harder for us to prescribe medicines to our patients because Medicaid here has very rigorous policies regarding things like eye drops; the majority of our Medicaid patients require a pre-authorization in order for us to order them these drops and other necessary drugs.

I am sure that the list goes on and on and quite frankly, I am even more positive that you don't want to read it here on this humble blog. However, what we can take away from these issues is this: ObamaCare is most likely not going to make your practice more profitable at first, though that may change in the long run. In order for you to provide the best service possible to your patients it is going to be important to direct your staff to diligently verify patient benefits and COLLECT MONEY FROM YOUR PATIENTS UP FRONT! Make sure you are having patients fill out ABN's and HIPPA notices that clearly describes and defines these activities and makes them aware that they will be responsible for any out-of-pocket charges at the time of service. If you don't, the signs are pointing to higher Accounts Receivable numbers and that is a situation you don't want to put your self in.

Click Here to reach opticXpress today, we can help you navigate ObamaCare in your Practice!