[MMA News Now, Feb. 27, 2014]
The MMA has signed on to a letter to be sent to the Centers for Medicare and Medicaid Services (CMS) regarding the 90-day grace period for Affordable Care Act-subsidized health insurance exchange products that could put physicians on the hook for consumers who don’t pay their bills.
Under the ACA, consumers who purchase health insurance plans on an insurance exchange with premium subsidies (Advance Premium Tax Credits) are entitled to a three-month grace period if they miss a monthly premium payment. During the first 30 days of the grace period, insurance companies are required to pay for any claims submitted. However, they are allowed to “pend” any claims submitted during months two and three of the grace period, and may ultimately deny such claims if the consumer does not make the missed payment.
The AMA, along with the Medical Group Management Association, drafted a letter to CMS Administrator Marilyn Tavenner voicing concerns about the grace period’s impact on physicians and urged the organization to communicate clearly and timely with physicians when patients enter the first month of the grace period.
“Timely notification that patients have entered the grace period will enable physicians to educate patients about the importance of paying their monthly premiums, as well as help physicians anticipate or mitigate the effect of potential claim denials in months two and three of the grace period and better manage the financial aspect of the patient encounter,” the letter states.
The MMA has also communicated its concerns about the grace period and the need for timely notification to physician practices to the Minnesota Council of Health Plans. The MMA intends to monitor the frequency of both the non-payment grace periods and the timeliness of health plan notification. Physicians who experience pended or denied claims are urged to contact MMA
with their experiences.