Medical Billing Blog

The Real Deadline to Sign-Up for the Affordable Care Act

Posted by Scott Shatzman on Wed, Oct, 16, 2013 @ 10:10 AM

MBR Take-Aways

  1. If you want your coverage to begin on January 1st, 2014, you must acquire insurance before Dec. 15.
  2. February 15th, 2014 is the last day you can get coverage and avoid being liable for a penalty.
  3. Open enrollment period actually will run until the end of Mar. 2014.

 

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EHR Adoption Surpassed 2013 Goals

Posted by Scott Shatzman on Tue, Oct, 01, 2013 @ 14:10 PM

MBR Take-Aways

  1. HHS has met its 2013 goal of EHR implementation.
  2. Over half of all eligible providers and over eighty percent of hospitals use EHRs.
  3. More than 291,000 EPs and more than 3,800 eligible hospitals received incentive payments from the federal government.

Health and Human Services (HHS) Secretary Kathleen Sebelius announced that HHS has already met and exceeded its 2013 goal of EHR implementation. With significant incentives from the federal government, more than half of all eligible providers (EPs) and over eighty percent of eligible hospitals nationwide are demonstrating meaningful use of electronic medical records (EHRs). This is a considerable increase in just five years. According to a 2012 Centers for Disease Control and Prevention survey, the percent of physicians using an advanced EHR system was pegged at 17 percent in 2008, while hospitals, only just 9 percent had adopted the technology. In a statement, Secretary Sebelius said, “We have reached a tipping point in adoption of electronic health records. Health IT helps providers better coordinate care, which can improve patients’ health and save money at the same time.” Electronic medical records play a vital role in President Obama’s signature healthcare law, the Affordable Care Act. Powerful incentives were made available for EPs to offset some of the initial costs. More than fifty percent of eligible physicians have capitalized by taking advantage of this subsidy. Some of the broader goals of the ACA are to improve care coordination, reduce duplicative tests and procedures, and reward hospitals and physicians for keeping patients healthier, all of which are supported by widespread use of EHRs. 

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Health Exchange 101: Understanding the Plans

Posted by Scott Shatzman on Wed, Sep, 25, 2013 @ 12:09 PM

MBR Take-Aways

  1. There are five different coverage options, all with a different cost structure.
  2. All plans will include a basic list of benefits.
  3. The Affordable Care Act does not require coverage for dental, vision, disability, life and critical illness to be listed on the exchange. 
On October 1 st, all across the country, health exchanges will open for individuals, families and businesses to compare and purchase health coverage, as mandated by the Affordable Care Act. These exchanges are a key component to reducing overall healthcare costs.
 However, most health care consumers may not be familiar with the differences in coverage options, and why an exchange plan may or may not be right for them. We have attempted to break down the five different coverage options below so you can have a better understanding for when the exchange opens next week.
There are five different coverage options:
  • Catastrophic plans offer limited physician’s visits, and higher copays, deductibles, and lower monthly payments. Only individuals under the age of 30, or that qualify for the “hardship exemption” are eligible the purchase a catastrophic health plan.

  • Bronze plans will have coinsurance levels of 60%.

  • Silver plans will have coinsurance levels of 70%.

  • Gold plans will have coinsurance levels of 80%.

  • Platinum plans will have coinsurance levels of 90%.

  Copays, deductibles and co-insurance will be highest for consumers enrolled in a “bronze” level plan. However, these enrollees will pay the lowest monthly premiums among all five coverage options. The highest monthly premiums will be through platinum plans, but enrollees will pay lower out of pocket expenses, such as reduced copays and deductibles.  
No matter what plan you select, all health plans will provide specific benefits to consumers. A health plan must provide these services to be listed on an exchange. The following is a list of benefits covered by any plan offered:  
  • ambulatory patient services

  • emergency services hospitalization

  • maternity and newborn care

  • mental health and substance use disorder services including behavioral health treatment

  • prescription drugs

  • rehabilitative and habilitative services and devices

  • laboratory services

  • preventive and wellness services and chronic disease management

  • pediatric services (including oral and vision care)

  It is important to note that for some small businesses and individuals, dental, vision, disability, life and critical illness policies probably won’t be covered under the various exchange plan options. The Affordable Care Act does not require coverage for these services to be listed on the exchanges. Consumers will most likely have to obtain these coverages through the private market. 
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Obama Administration Releases Premium Costs of Health Plan

Posted by Scott Shatzman on Wed, Sep, 25, 2013 @ 09:09 AM

MBR Take-Aways                      

  1. The “silver plan” will cost an average of $328 a month for individuals across the US
  2. Prices were lower in states with more competition among insurers and higher in states with fewer players
  3. The Obama administration is counting on signing up 7 million Americans in the first full year of reform

On Tuesday, the Obama Administration released the first detailed look at premiums to be charged to consumers for health insurance bought on the new insurance markets mandated by the 2010 Patient Protection and Affordable Care Act. Information released on Tuesday is based on approved insurance plans in the 36 states where the federal government will operate the insurance exchange.

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