Physicians Urged to Verify Patients’ Eligibility and Benefits January 13, 2014 Payment, Physician Resource open enrollment, Affordable Care Act, Benefits, Eligibility, physician payment 0 The beginning of the new calendar year means that deductibles and visit frequency limitation start over; however, because of open enrollment for health insurance under the Affordable Care Act (ACA), there may be changes to patients’ benefit plans in 2014. It is therefore vital for physicians to be aware of the numerous coverage changes that may have transpired, and to also be diligent in verifying patients’ eligibility and benefits so that proper payment is received for services rendered in 2014. Challenges that may affect physician payment in 2014 include: Medicare Patient Enrollment Modifications – From October 15 through December 7, Medicare patients were allowed to switch between Medicare fee-for-service and Medicare Advantage (MA), or switch from one MA plan to another. Medi-Cal Expansion – Under the ACA, California will expand Medi-Cal eligibility to childless adults ages 19-64 with incomes up to 138 percent of federal poverty level, effective January 1, 2014. An estimated 1.6 million individuals may become eligible for Medi-Cal/Medi-Cal managed care under the expansion. Patient Policy Cancellations – With 900,000 individuals having received policy cancellation notices from their current health plans that failed to meet the ACA’s minimum benefits requirement, many of those patients will have different plans and/or benefits effective January 1, 2014. LIHP Transition to Medi-Cal Managed Care – Approximately 600,000 patients previously insured through the Low Income Health Program (LIHP) will be transitioned into Medi-Cal managed care plans on January 1, 2014. Covered California Enrollment – It is estimated that anywhere from 150,000 to 450,000 individuals will enroll in an exchange plan through Covered California in 2014. Comments are closed.
