New Affordable Care Act measure gives patients more rights and help with their health insurance and health choices, but what does this newly expanded provision mean to healthcare providers?

The Affordable Health Care Act was signed into law in March of this year. It seems to be as rough a draft as the ARRA stimulus provisions in that they are continuing to be expanded and defined as they go. The new features expanded/added last week (see the official July 22 News Release) involve a desire to put patients more in charge of their healthcare and to give them better protection by giving them rights of appeal in claim and procedure denials. Per the news release: “Consumers in NEW health plans in every State will have the right to appeal decisions, including claims denials and rescissions, made by their health plans.” The plan is that there will be a set of standards and “defined and impartial” appeals method for your patients allowing them access and help with knowledge and protocols to be able to ask and work options for both internal and external appeals processes. This new, expanded provision also grants, by application, $30 million for Consumer Assistance Programs to create or strengthen existing offices to help your patients appeal decisions made by their insurance companies as well as to help them decide on appropriate health plans and insurance options for them. The appeals standard looks to have come from the National Association of Insurance Commissioners (NAIC) and per the Fact Sheet (listed below) States are “encouraged” to adopt the NAIC external appeals laws as their State appeals laws before July 1, 2011. The combined effect of these enhanced patient protections and the NAIC appeals laws are roughly listed next.

Office Financial Policies: Do you have one?

Management Corner
By Kathleen Wrolbel-Erlich CMOM, CPC

Office Financial Policies:  Do you have one?  How about some pointers to get you started?

Create a financial policy.  Have the doctor agree that this is his/her expectation of the patient.  Then have all of your patients sign a copy as they come in for visits.  You can also post copies by the front desk to remind patients if they forget. It is extremely important that the doctor, staff, and patients all have an understanding of your office’s financial policy.  Adjusting off money, because of a misunderstanding with a patient, is frustrating for both you and the patient.

Genius Focus Group- Warren (with goodies)

By Penny H, Genius blogster, news editor, & Focus Group participant

Wow, it was a whirlwind week last week.  It took me the entire weekend for my head to come back to earth and settle down.  Warren was a lot of fun!  The dynamic was a bit different in Warren because we had so many more people.  We also tried a different room setup, instead of rows of chairs and tables we were able to try a giant horseshoe of chairs and tables so that everyone could see each other and we could see them.  I think I can safely say that all of those who presented really liked it, and the comments coming back from you were that the layout was equally well-liked by you.  It seemed odd at first, having a giant space in the middle, but it really was much easier for all of us, to well, see all of us.   I just wanted to give a quick review with some tips for those that were there (or were not able to be there).  I'll also be giving you a link to download the printed materials we gave out (.pdf) so you can have it on your computer, or be able to print out more copies if needed.

Genius Fall Training Schedule Posted

The Fall Training Schedule has been posted, please choose your classes, then download and return the form to us.  If you have questions on any of the classes, please e-mail training2009@geniussolutions.com or contact Training at 586-751-9080 / 800-645-0955

Genius Focus Group- Mt. Pleasant

Yeah, we had our first Focus Group meeting yesterday.  Sherri and I (aka me, Penny, Genius blogster) were out in Mt. Pleasant yesterday.  We would like to give a shout out to everyone who came out the Mt.Pleasant Focus Group yesterday.  It was a great group, with a very relaxed atmosphere at the golf resort; they made us feel very welcome and very comfortable.  We hope we did the same for them.