Thousands of physicians across the country are involved in class-action lawsuits alleging that the nation’s largest insurers are involved in a “conspiracy … to deny, delay and diminish payments to health care providers.” [1] According to the Heritage Foundation, the denial rate for Medicaid is three times that of private insurance companies, and the lag time between the date of service and the date of payment is twice as long.[2] Collecting payments from insurance companies and Medicaid can be a nightmare for healthcare providers, and it is only going to become more difficult.
Under the Patient Protection and Affordable Care Act, Medicaid will cover eighteen (18) million new patients, and if procuring payment from the government caused a headache before, those eighteen (18) million new patients are not all that the Act offers health care providers. Physicians can now look forward to more governmental regulations, red tape, and bureaucracy, which will further impede claims and payment process. The Act creates over one hundred fifty (150) new boards, commissions, and programs to decide what benefits insurance companies must offer, to whom they must be offered, and what they must charge for those benefits. The new bureaucracies will also determine what insurance coverage employers and individuals must purchase and at what cost , what is considered quality care and what is not, and what services doctors will be paid for and when.
Section 3403 of the Act creates an Independent Payment Advisory Board. The Board will consist of fifteen (15) members, appointed by the President, and its job will be to decide the fair market value of physicians’ services. According to Dr. Jeffrey B. English, a government board cannot decide the fair market value of a service, “they will make decisions based on politics and undoubtedly will underpay physicians.” [3] The Board’s goal is to reduce the per capita growth rate in Medicare spending, and make recommendations for slowing growth in non-federal health programs. [4] In other words, the Board will make recommendations for reducing spending, i.e. cutting payments to physicians.
In 2008, more than fifty-four percent (54%) of doctors surveyed by the Physicians Foundation rated reimbursement issues as “most unsatisfying”.[5] The result of removing free market principles from the health care system and adding hundreds of bureaucracies, under which it must now function, can only be lower physician payments, slower payment schedules, and higher denial rates. As it is, doctors must haggle with insurance companies to procure insufficient payment for their services and the Patient Protection and Affordable Care Act will only make the claims process more difficult to navigate.
Special thanks to Shelley Riseden for her help on this piece.
The Agresta Firm’s health law practice is experienced and ready to handle your medical claims. Please contact us for more information about how the Patient Protection and Affordable Care Act can help you.
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[1] Los Angeles Times, The Battle over Bills, 2008
[2] Heritage Foundation, Obamacare and Medicaid: Expanding a Broken Entitlement and Busting State Budgets, 2011
[3] Dr. Jeffrey B. English, Obamacare 2010: Politicians Want A “Good Story”, Basil & Spice, 2010
[4] Physicians News Digest, Obamacare and Its Impact on Doctors, 2010
[5] Heritage Foundation, Obamacare and Medicaid: Expanding a Broken Entitlement and Busting State Budgets, 2011
