SNF eligibility

New health insurance eligibility game plans needed for 2017

As the days left in 2016 start to dwindle, medical providers would be wise to start thinking about the usual churn of patients in new insurance coverage that comes every January. The time to plan is now. Although plan membership can change at any time during the year, it is the first of the year that most often reshuffles the deck.There are many reasons new coverage is getting more complicated, from employers shopping for better deals, to an aging population landing more beneficiaries in Medicare, to an influx of uninsured Americans gaining coverage through Medicaid and exchange plans. For some patients, it’s as simple as swapping out the cards in their wallets. For others, it’s entering a whole new world – with some becoming insured for the first time in their lives.

Challenges for Providers on the Horizon

Patients Who are Previously or Newly Confused

  • Even previously insured patients may have trouble understanding basic insurance rules and terminology – including rules affecting what they owe providers. Patients new to the insurance world are almost guaranteed to be confused.
  • Some newly insured patients will include people turning 27 years old and falling off their parents’ insurance plans as set by law.

Plan Changes for Exchanges, Medicaid and Cooperatives

  • Medicaid beneficiaries may unknowingly be enrolled in a plan by the state if that state moves from traditional Medicaid to Medicaid managed care. Some states phase in managed care county by county, so these shifts can happen throughout the year. Providers may suddenly be working with traditional payers instead of directly with Medicaid.
  • Some exchange patients are changing coverage in 2017 because their plans are pulling out of a particular geographic region.
  • Cooperative members may have started new coverage also since many of these plans have closed.

Medicare Surprises and Plan Loyalty

  • Some patients who have just turned 65 may find themselves unknowingly enrolled in a Medicare Advantage plan. If they were enrolled with an insurer and didn’t opt out at the right time, they were automatically transitioned. These so-called “seamless conversions” can cause practices to lose patients.
  • Providers shouldn’t count on lifetime loyalty from Medicare patients. While many choose a plan with a physician or hospital in mind when they first enroll, Kaiser Family Foundation research shows that they will give up favorite providers before they will slog through another pile of plan materials at open enrollment.

Be Ready for Next Year!

  • Doubling down on eligibility checks and timely and accurate claims submission is important to the financial health of your practice.
  • An efficient eligibility check system is essential and should be used for every patient visit.
  • Catching eligibility errors at the front end is critical to avoiding having to resubmit rejected claims.
  • Having the ability to batch-check eligibilities saves valuable time and can be automated.

We Can Help!

With ABILITY applications, you can improve efficiency, increase cash flow and maximize your revenue! For more information on how ABILITY can help, click here.