January 22, 2020
Area(s) of Interest: Public Payors Payor Issues and Reimbursement Practice Management
Physicians are reminded that the open enrollment period for Covered California ends on January 31, with coverage effective February 1. More than 269,000 consumers have newly signed up for health insurance through Covered California during the current open-enrollment period, which is an increase of 18% over last year. In addition, more than 1.15 million existing Covered California members have renewed their coverage for 2020.
Don’t get stuck with unnecessary denials or upset patients. Physicians are urged to be diligent in verifying patient eligibility and benefits to ensure that they will be paid for services rendered. It is extremely important that practices verify eligibility on all exchange patients, ideally on the date of service, or as near the time of service as possible. Practices should also retain a printout/confirmation of the eligibility verification and include it as part of the patient’s record. If a patient's eligibility verification comes back indicating the patient is not covered, practices may give the patient the option to either pay cash at the time of service or reschedule to a later date if the appointment is for non-emergency services.
The end of open enrollment and beginning of a new year also means calendar year deductibles and any visit frequency limitations start over. Many of the exchange/mirror plans have high deductibles (e.g., $6,300 medical deductible for an individual on the Bronze plan). With open enrollment, there may also be changes to benefit plans, or patients may even be insured through a different plan. This reinforces the importance of verifying eligibility each time the patient is seen.
Verifying eligibility will also alert the practice as to whether the patient may be delinquent in paying their premium and, as such, is in the federal three-month grace period. For more information on the grace period, see CMA’s resource, “Covered California: Understanding the Grace Period for Subsidized Exchange Enrollees.”
Taking these proactive steps to protect your practice by preventing denials, delays in payment and disgruntled patients goes a long way toward ultimately saving time and money.
To help physician practices understand their participation status, which products are being offered and what changes to expect, the California Medical Association has published a new tip sheet, “Surviving Covered California: Preparing for changes in 2020.” The tip sheet is available free to members.