The Medical Group Management Association has expressed concerns about provider liability related to a 90-day grace period for unpaid health insurance premiums under the Patient Protection and Affordable Care Act.
Federal officials require insurers offering coverage through the new health insurance exchanges to provide a three-month grace period for people who haven't paid their premiums. Although the insurance companies must pay for claims filed during the first 30 days of the grace period, they will hold claims made during the last 60 days.
If patients don't ultimately pay their premiums and their coverage is cancelled, insurers aren't obligated to pay for the services provided during those 60 days, potentially placing a "significant" burden on physicians, who must try to collect the amount owed directly from patients, MGMA President and CEO Susan Turney, MD, wrote in a letter to CMS Administrator Marilyn Tavenner.
CMS has issued guidance advising insurers to notify providers "as soon as practicable" when a person enters the grace period. However, Dr. Turney wrote this instruction is too vague and insurers should notify providers a patient has entered the grace period by at least day 15 of the 90-day time span.
"As part of a real-time eligibility verification request, it is essential for practices to have accurate, up-to-date information in order to work with patients and plan accordingly for potential financial liabilities associated with non-coverage," Dr. Turney wrote.
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