Managing ACA-Insured Patients

Roberta Schultz

Thanks to the Affordable Care Act, millions have health insurance who in the past could not afford it or qualify for it. But this new widespread adoption of insurance is creating a new class of patient that requires special attention by the healthcare providers that serve them.

While we are only a few months into this nation’s grand experiment with conditional universal healthcare, the impacts are already being felt. But the challenges and risks are only just beginning to materialize.

One of the risks that many identified well before the ACA took effect was the latency between a patient’s coverage and the payment for that policy. Patients have a 90-day window to pay on their policy before it is suspended. But any medical expenses accrued during that period can be retroactively denied. And if the patient eventually doesn’t pay the bill, the provider will be on the hook to collect the debt.

There are many other risks that will present themselves over the coming months and years, which is why healthcare providers must understand that patients insured under the ACA are separate from self-pays, Medicare, Medicaid, and other insured patients.

Obviously we are not advocating these patients be treated differently on the clinical side, but in a provider’s financial systems there should be a way to distinguish those newly insured under the ACA so they can be tracked, aggregated, analyzed, and, most of all, receive the support they need so that their financial obligation does not become a financial burden.

All about education

For many patients who purchased insurance via an ACA exchange, this will be the first time they have ever had health insurance, and for a small percentage, the first time they ever have purchased any kind of insurance. Others will be familiar with health insurance, but because in the past they have received it from an employer, they must now write that check to the insurance company instead of having it deducted from a paycheck.

It will be up to healthcare providers to help patients make this transition because, frankly, no one else will—not the insurers, not the federal or state governments that run the exchanges. Education has now become the responsibility of providers because as a group, they have the most to lose.

Providers should consider establishing an education curriculum for patients who purchased insurance through an exchange. Rather than hand the patient a form for their signature with legalese stating they will pay their financial obligation, instead have a conversation with the patient explaining what that means and what is expected of them.

It goes without saying that a conversation about financial obligations needs to occur as early as possible within the patient account lifecycle, such as when the patient seeks that first appointment or when obtaining a primary care physician.

In the Next Blog: Aligning financial systems with ACA-insured patients

Roberta Schultz is Director of Operations at ProSource Billing, Inc., a part of the Array Services Group family of companies. Roberta has over 23 years of healthcare Revenue Cycle and A/R management experience which includes managing various revenue cycle projects for multiple healthcare facilities including physician, hospital, and healthcare organizations.