Affordable Care Act

As it relates to ACA there are too many moving pieces to cover in the time and space allotted.  Yet there are three basics to consider as the year starts:

1.      Are you participating in plans offered in the exchange and if so what is your reimbursement like?  Do not trust anyone and ask the following questions:

·         What products, that you participate with, are sold on the exchanges?RX ACA

·         What is my fee schedule for those services covered under this program?

         Note: do not accept number based on Medicare or Medicaid schedule.  Instead ask for a list based on the CPT schedule.

·         How many lives in your area are enrolled in this product(s)?

2.      Are you prepared to receive cash for services?  Keep in mind that many of the “new” products have a high deductible so you must be sure having in place the right accounting and tracking mechanism or risk losing some money.

3.      Are you in compliance with the Office of the Inspector General Guidelines.  Remember that ACA made this requirement a requisite for health care providers and organizations and that simply having a set of policies and procedures will not meet the requirements of the law.  As a minimum conduct an internal audit, update your policies, assign a compliance officer and train your staff.

·         A good idea will be to validate your personnel against the OIG database at the beginning of the year.  While you are expected to do this monthly and every time you hire a new employee at the very least start doing it at the beginning of the year.

Note: Plans under the ACA have an effective date of January 2014, however many computer systems have not been able to process the individual applications so expect an increase in time trying to verify benefits and obtaining authorizations.