Mar. 25—Physician advocacy groups are asking the Obama administration for new rules to protect physicians from having to absorb unpaid expenses incurred by patients who let their marketplace coverage lapse.

A provision that gives consumers a 90-day grace period before cancellation of unpaid policies purchased on the new government-run health insurance marketplaces has drawn concern from hospitals and other providers since the provision was first proposed last year. Rules implementing the Affordable Care Act provision require providers to be responsible for any care costs incurred from 30 to 90 days after a policy lapses due to premium nonpayment. Insurers would have to pay any costs of care incurred in the first 30 days of a policy's lapse due to nonpayment of premiums.

The American Medical Association (AMA) and 85 other physician advocacy groups recently urged the Centers for Medicare & Medicaid Services (CMS) to amend the grace-period rule to require insurers to notify physicians as soon as patients fall behind on their premiums. The change has been sought by various physician advocates since the grace-period rules were first proposed in the summer of 2013. Current notification requirements give insurers discretion as to when and how to notify physicians during the 90-day grace period.

“Timely notification that patients have entered the grace period will enable physicians to educate patients about the importance of paying their monthly premiums, as well as help physicians anticipate or mitigate the effect of potential claim denials in months two and three of the grace period and better manage the financial aspect of the patient encounter,” the physician advocacy groups wrote to CMS.

To help physicians impacted by the grace period rule, the AMA recently issued assistance tools, including a grace-period collections policy checklist and a sample letter for physicians to send to patients to notify them that they will be billed for the full cost of care in the last 60 days of grace period.

Publication Date: Tuesday, March 25, 2014