Exchange Plans Creating Administrative Headaches for Many Practices
Wednesday, June 04, 2014 05:11 PM

The Medical Group Management Association (MGMA) recently conducted research to explore the impact of the Patient Protection and Affordable Care Act exchange plans on medical practices. The results indicate that many practices are experiencing difficulty when patients with coverage under an exchange plan come in for their appointment.

Sixty two percent of respondents reported having difficulty even identifying that a patient has coverage under an exchange plan because it isn't obvious based on the insurance card. And once practices know that a patient is covered under an exchange plan, they report having to spend up to 20 minutes on the phone just to verify benefits (as opposed to the automated systems available with most traditional commercial plans).

Even more frustrating has been the fact that once benefits are verified, more than half of the practices found that they were not even able to see the patient because they were out of the plan's network. In a news release from MGMA, Dr. Susan Turney, president and CEO, summarized the frustration of many practices: "The more administrative complexity introduced into the healthcare system, the less time and resources practices can devote to patient care." The research wasn't all bad news, however. Many practices reported being paid slightly better by the exchange plans than they had anticipated. Look for a new Benefits Verification Form to be released by ACA soon to help members navigate this process.

Source:  ACA Week in Review, May 29, 2014