Tools available: Access fact sheet, bulletin on the 90-day grace period

Monday, September 08, 2014 02:14 PM

The Colorado Medical Society has developed a fact sheet on the 90-day grace period. Authorized under the Affordable Care Act, the grace period allows for continuity of care in the case that patients miss health insurance premium payments but could put doctors on the hook for collecting payments from patients for past services. The key to protecting your practice is checking 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.

> Click here to access the fact sheet

Earlier this year the Colorado Division of Insurance (DOI) issued proposed regulations to establish the requirements for the grace period when the policyholder is delinquent in the payment of monthly premiums. CMS and 10 other organizations submitted comments to strengthen the timing of the notification of physician practices and details required to be included in the notice.

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 a bulletin, B-4.77, to carriers in August that provides additional direction. CMS is pleased to report that many of the suggestions we made 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.

We would like to thank Commissioner Salazar for taking the concerns of physicians and other providers into consideration. The bulletin will go a long way to ensuring that physicians and others receive consistent and timely information from carriers concerning their patients’ eligibility status.

> Click here to access bulletin B-4.77