Even though many provisions of the Patient Protection and Affordable Care Act are implemented in 2014, some are active right now. Many of these changes will affect what the covered services are for your patients, or even who will be eligible for coverage in the first place. Consequently, the practitioner will be able to potentially provide service that was not covered in the past.
Examples of coverage related changes due to heatlhcare reform:
- Young people can remain on parents’ health insurance until age twenty-six.
- There can be no discrimination against children with pre-existing conditions.
- No dropping people from coverage when they get sick.
- There will be no lifetime limits on coverage.
- New plans must offer free preventive care.
- There will be an expanded ability to appeal decisions made by the health plan.
In addition to the changes in coverage for your patients, there are a number of requirements and operational impacts that providers are needing to reckon with. These changes can in some cases be far reaching, and require some fundamental reorganization for a number of solo and medical group practices.
Examples of operational changes in a medical practice due to healthcare reform:
Physicians and other providers applying for Medicare participation will be required to have a medical Compliance Program in place. It is yet unknown if this requirement will extend to an existing Medicare participating medical group which is adding a physician or other practitioner who has not previously participated in Medicare, but it’s safe to assume that that’s the direction things are moving.- States may use Recovery Audit Contractors (RAC’s) for audits of state Medicaid programs. So anticipate more frequent and in-depth scrutiny. Developing and implementing effective Compliance Policies and Procedures that include internal monitoring, and risk-based coding and medical documentation, have become essential.
- Efficient and effective medical group operations have always been sought, but as reform measures bring about the above described scrutiny, be aware of how much more critical billing practices, personnel management, and general practice operations are going to be if you are to prosper in this new environment. If you’re unsure about your current status, or know that there are some rough spots, but are struggling to find solutions, consider having an independent third party review by a qualified healthcare management consultant. Someone who can properly review, evaluate, and give sound advice on necessary modifications. And someone who can help you put those changes in place.
Like so many policy changes, healthcare reform in this country is less than what some hoped for, but more than what others envisioned. That being said, it no doubt is going to play a significant role in physician practices. And the requirement for an effective compliance program formally transitioning from voluntary to mandatory should certainly be a catalyst for taking these changes seriously. Like with most things in business, being proactive is typically easier and more profitable than the alternative.