September 2014
Learn more about virtual credit card payments with resource and webinar
An increasingly common payment method among health insurers offers these companies significant financial rewards while sticking physicians with all the associated fees and extra work. But physicians are fighting back as the American Medical Association, MGMA and other health care associations take the issue to the federal government, the AMA reports.

Many insurers are choosing to use virtual credit cards for claims payments to physicians, instead of sending paper checks or paying via the electronic funds transfer (EFT) standard transaction. When paying via virtual credit card, insurers send single-use credit card payment information and instructions to physicians via mail, fax or email. The physician's office staff then processes the payment as they would a patient's credit card.

For each of these payments, physicians are charged fees that typically amount to 3-5 percent of the total payment, the AMA explained in recent testimony (log in required) to the National Committee on Vital and Health Statistics, an advisory board to the secretary of the U.S. Department of Health and Human Services (HHS).

That adds up. If a physician contractually is owed $5,000, for instance, he or she could have to shell out up to $250 in fees.

In addition, physicians' practices are forced to devote more time to processing these payments, having to manually enter information, correct any entry errors and manually reconcile the payment with the separate claims remittance advice.

Insurers, on the other hand, often receive cash-back incentives for making virtual card payments, including a portion of the fees the physician paid.

The AMA is urging HHS to issue additional guidance on this issue. In a letter (log in) sent last week to HHS Secretary Sylvia Burwell, the AMA, MGMA and two other leading organizations called on the agency to prohibit insurers from forcing physicians to accept this payment method. They also urged the agency to require insurers to give full upfront disclosures of associated fees, obtain physician authorization before implementing virtual card payments and ensure an easy opt-out process if a physician later chooses not to accept this form of payment.

Physicians instead can request insurers to pay via the EFT standard transaction, which works like direct deposit and can cut down the time spent on processing paper checks.

A free continuing medical education webinar, "Stop paying to get paid: Effective electronic payments," will take place at 10 a.m. MT Sept. 16. Click here to register. The AMA has created a resource that explains your rights concerning acceptance of virtual credit card payments. Click here to read more.

Tools available: Access fact sheet, bulletin on the 90-day grace period
Earlier this year the Colorado Division of Insurance (DOI) issued proposed regulations concerning grace periods for policyholders receiving federal advance premium tax credits (APTC) per the Affordable Care Act (ACA). The purpose of the regulation is to establish the requirements for grace periods when a policyholder is delinquent in the payment of monthly premiums for health benefit plans offered on the state's health insurance exchange (Connect for Health Colorado).

By issuing this regulation the DOI had an opportunity to provide additional clarity to the 90-day grace period that was not addressed in ACA. However, the rule fell short. Neither the ACA nor the proposed regulation provided carriers with specific direction about the type and notification timing of critical information sent to providers regarding a patient's eligibility status.

Physicians and the provider community as a whole expressed concerns regarding the potential financial burden they face when they do not receive timely notification about when a patient enters the second and third month of the grace period. This uncertainty could become a disincentive for physicians to participate in the health plans offered through Connect for Health Colorado.

While Insurance Commissioner Marguerite Salazar concluded that the DOI does not have the authority under current statute to incorporate the changes requested, she did issue an August bulletin to carriers that provides additional direction. Specifically, we are pleased to report that many of the CMS' suggestions were accepted concerning what information is reported about a patient's eligibility status within the 90-day grace period and when physicians are alerted. The bulletin also clarifies the relationship between the grace period and the existing statute on eligibility verification.

The bulletin, B-4.77, will go a long way to ensuring that physicians and others receive consistent and timely information from carriers concerning their patients' eligibility status. CMS has developed a fact sheet that can be found on the CMS website, along with a copy of the bulletin. The key to these protections lies in the physician practice's hands. It is important to check the patient's eligibility status prior to services being provided so that financial arrangements can be made in advance of potential problems later related to unpaid patient premiums.

ICD-10 Testing
A recent issue of the CMS MLN Matters addresses the Medicare Fee for Service approach to ICD-10 testing, including information on how you can take advantage of the availability of three separate weeks of acknowledgement testing. Click here to read more.

In This Issue

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"Stop Paying to Get Paid: Effective Electronic Payments"
Tuesday, Sept. 16, 2014
10 a.m. MT
An AMA webinar designed to provide attendees with knowledge of electronic payments, an overview of the implications of accepting virtual credit card payments, and an introduction on how to implement the new HIPAA standard electronic funds transfer transaction into the practice. Register here.

PQRS: "How to avoid 2016 negative payment adjustments"
Wednesday, Sept. 17, 2014
11:30 a.m. MT
This MLN Connects National Provider Call provides an overview of the 2016 negative payment adjustment for several Medicare Quality Reporting Programs. It will cover guidance and instructions on how eligible professionals can avoid the 2016 PQRS negative payment adjustment, satisfy the clinical quality measure component of the EHR Incentive Program and avoid the automatic CY 2016 Value-Based modifier downward payment adjustment. Register here.

"Low-Cost, High-Impact ICD-10 Action Steps for Providers"
Thursday, Sept. 18, 2014
11 a.m. MT
WEDI is hosting this free webinar offering low-cost coding, workflow and technology action steps providers can take now that will prepare them for the transition to ICD-10. Register here.

2014 Workers' Compensation Fee Schedule Educational Seminar
Beginning Oct. 2, 2014 and continuing through Dec. 4, 2014, the Colorado Division of Workers' Compensation will be offering programs across the state to update the billing and payer communities on Rule 16 (Utilization Standards) and Rule 18 (Medical Fee Schedule) changes that will be effective Jan. 1, 2015. Click here for registration information.

Submit your event by e-mailing [email protected].

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