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New AMA resources provide step-by-step guide for minimizing ACA grace period risk

The American Medical Association has posted new resources to assist physicians navigating a little-known rule in the Affordable Care Act (ACA) that could pose a significant financial risk for practices. Published by Centers for Medicare & Medicaid Services (CMS), the rule provides individuals that purchase subsidized coverage through the state and federal insurance exchanges a 90-day grace period before their coverage is cancelled for non-payment.

Under the CMS rule, insurers in health exchanges are required to pay any claims incurred during the first 30-days of the grace period, but insurers are not required to pay claims incurred during the last 60-days for any patient whose coverage is terminated. Patients are considered to be covered for care during the entire grace period, but insurers are allowed to place all the claims during the last two-thirds of the period in a pending status and retroactively deny them when coverage is terminated at the end of the grace period.

Physicians resources include:

These resources are geared to the needs of physicians and will help support their practices by outlining key issues associated with the grace period and provide guidance on administrative policies, financial agreements and communications with patients and insurers.

A key issue for physicians is having accurate information from health insurers regarding patients’ grace period status. The Society recently signed onto this letter urging CMS to amend the grace period rule to require insurers to notify physicians as soon as a patient falls behind on their premiums, rather than the current notification requirement that provides insurers with discretion as to when and how to notify physicians during the 90-day grace period. In addition to the AMA and the Society, the letter was signed by nearly 100 specialty organizations and state medical societies.

Additional ACA resources are available on the AMA’s website and the Society’s website.

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