Accepting and Managing Health Insurance Exchange Patients, A Reality Check
The first in a series of Quill Healthcare webinars, Steve Selbst and Susan Charkin will provide medical practices with guidance and information about effectively managing patients in any state or federally-managed state health insurance exchange.
The webinar includes a recently completed survey of 13 payers across 10 representative states. This survey provides payer responses to health insurance exchange practice management questions ranging from how practices are enrolled and verified in insurance exchanges to claims verification processes.
View the webinarSponsored by Quill.com
Co-hosted by HealthCents, Inc.
Video Transcription of Accepting and Managing Health Insurance Exchange Patients, A Reality Check
Steve: Hello and welcome to "Accepting and Managing Health Insurance Exchange Patients, A Reality Check." This session is the first in a series of value-added webinars for Quill.com customers and healthcare customers sponsored by Quill.com Healthcare for the benefit of teaching medical practices and medical providers state-of-the-art techniques and value-added information about the healthcare industry.
Today's topic about managing health insurance exchange patients is certainly a very current and relevant topic since most practices today are dealing with the rollout of the Affordable Care Act and the new participation of patients in the health insurance exchanges.
Before we begin the content of this session, the first thing I would like to do is cover a couple of administrative matters that will actually help to make this both interactive and a rewarding as well as I believe a fun session for all involved.
The first thing I'd like to mention is that if you have a question at any time during this webinar, you may send an email immediately to info@HealthCents.com, and my colleague, Ms. Susan Charkin, will be picking up your emails. During the various pauses that we have in this session, we'll be covering your questions and relying on our panel of experts, which includes me, Susan Charkin, my partner, as well as Regina Vasquez. Between the three of us we have over 40 plus years of healthcare experience and add to that another 30 years of large computing industry experience to bring value into this session and to converse with you about managing health insurance exchange patients.
So please don't hesitate to send any questions that you have to info@HealthCents.com real time, and I will be pausing at various logical points during the webinar so that we can discuss the questions that you have asked and give you maximum value as a result of your questions.
Secondly, during those same pause periods, there is an opportunity for you to ask live questions. All you need to do to ask a live question when we get to those pause periods, when prompted, is to simply press the *6 on your phone or cell phone, ask your question and keep the line open until we're done dialoging. Then please, out of deference to all of those on the call, mute your line once again when you're done conversing with us and simply press *6 a second time to do so.
So there are two ways to ask questions. You can send your emails instantly, if you prefer that method, to info@HealthCents.com, or you may simply press *6 on your phone and ask the question. When we get to the logical pause points, I will prompt you for those questions.
We're going to have an interactive session, much like in a ballroom if you've been to ballroom types of sessions, where the results get recorded in real time and you see bar graphs and line charts to essentially go over the results to the questions. Similarly, I am going to explain to you, as we go through, how to go about answering the three questions that we're going to ask. It's a very simple process, and we will discuss it when we get there.
If for some reason when you go to your browser and open up either a new tab or simply use another browser to answer those questions you lose the web portion of this session, don't worry. All you need to do is simply go back to any browser and type Join.Me/HealthCents, and once again you will be instantly connected back into this session at the exact point that we're at, and of course your phone line will continue to remain active throughout so you won't lose phone contact if that were to happen.
The best thing to do when you respond to these questions — and I'll step you through it — is to simply open up another tab in your browser or, if you prefer, use a second web browser other than the one that you're viewing this webinar on.
Now for those of you that have not used the Join.Me technology for webinars, you'll see a little floating bar that is kind of a greenish color with various circles and it looks like a computer in the center. In order to maximize the screen for viewing, the simplest thing to do is on that floating bar there is a Maximize button on the top right. You can press the Maximize button, a little square much as you see in a window on either a PC or on a Macintosh computer. You can simply click that Maximize button and it will maximize. There are more fancy ways to do it, but to keep it simple that's the best way to handle it is simply maximize your screen. It should pretty much take up your whole screen.
With that as a backdrop, this will be the first opportunity for a quick pause. Before I plow into the content here I will pause and just quickly ask if anybody has any questions, and if you do, I would ask you to please press *6 on your phone, identify yourself and ask your question. So a quick pause here for questions.
Okay, I take that as we're ready to go.
Susan: I'm sorry, Steve. This is Susan. We actually have a question.
Steve: Oh, very good.
Susan: This is just a general question on insurance companies. Should we wait, or should we answer the questions now?
Steve: As far as content questions, let's take that one first, but let's get past just this immediate introductory material for any content questions. At this point, I'm just pausing for any administrative questions.
Susan: Got you. Okay, we'll wait with this one.
Steve: We'll come right back to it. So whoever sent that question in, thank you and that question will be the first one up to the plate as soon as we pause for content questions. Speaking of content, let's get started.
Introducing Quill Healthcare
First, I would like to introduce to you Quill Healthcare. Quill Healthcare is in the business of meeting the needs of your practice no matter what kind of practice that you're in. There's a broad array of products. Basically, every kind of product that you can imagine that your office can use, Quill.com Healthcare can provide.
We have over 125 practice experts with more than 100 decades of experience that are ready to help you succeed. We have a variety of capabilities that you'll benefit from, including the ability to record order history, review and product recommendations, to provide you with real-time notifications of regulation and policy changes that might affect your purchases and practices, form updates and custom imprint requirements, and the latest editions to our inventory and trends that are there to impact your practice.
The reason that Quill Healthcare, also known as Quill.com Healthcare, is putting on webinars like this is exactly for this purpose, and that is to bring additional value to medical practices, dental practices and, for that matter, any providers that purchase Quill Healthcare products and give you that value-add by providing industry-specific information that you can put to use in your practice. This is a service that Quill.com Healthcare is providing, at no extra charge whatsoever, simply to bring more value to you as practices so that you can be more profitable.
Agenda
Today's agenda is that we are going to focus on the health insurance exchange patient and how to go about handling them. I will tell you that this is not about giving you an editorial about whether or not this panel thinks exchanges are good, bad, or indifferent. You can get plenty of editorials from the local journals that you follow, whether it's newspapers, periodicals, the cable news channels, or your local news channels. There are more than enough industry pundits out there that have opinions about the Affordable Care Act.
We're here to actually not provide opinions about the pros and cons of the Act, but deal with the realities of it, meaning how do you go about managing patients that are in the health insurance exchanges to the maximum benefit of your practice and to providing quality services to those patients. That's really what this session is about.
We're going to do a little bit of a level set to make sure everybody is on the same page relative to the Affordable Care Act and health insurance exchanges. I think even that section will maybe give you a little bit of a different perspective than you might already have in that we've looked at this in terms of the consistencies and inconsistencies that exist across the federal and state exchanges.
We'll also talk about how to navigate health insurance exchanges and the management of health insurance exchange patients and specifically how to avoid some of the possible hazards in the road. We'll cover in detail what those potential hazards may be.
Then we are bringing a unique survey to the table. Our team of experts has conducted a survey of 13 different payers across a cross section of 10 different states, where we have gone out and asked 10 specific questions relating to the management of health insurance exchange patients to give you the perspective that the largest payers across the country have about managing exchange patients. I think you will find that that survey and the 10 questions that we asked and drilling into the insights gleaned from those questions will be of immense value to your practices.
Let's start with a question...
Now first off, we're going to start with a question. This is a team sport, folks, where I'd like you to participate in real time. The way that you do this is you go to HealthCents.com/Q1, again opening up another window on your browser or go to another browser, and you will see this exact question. Then simply pick the radio button for "Yes," "No," or "I don't know."
All we're trying to determine here is of those who are participating today, does your practice currently have patients who are enrolled in a health exchange product? Are you currently managing health insurance exchange patients? Right now, I will pause for about a minute, and I'd like everybody please to take a moment and go to HealthCents.com/Q1 and to please answer that question.
Just to go about showing you how to do this if you're having any trouble at all, you would simply go to your browser and, just like I'm doing here, go to HealthCents.com/Q1. There you go. Here's the question and pick the correct answer for you. There is no right or wrong answer here. It's yes, no, and we've actually had practices that don't know and that's okay too.
Please go ahead and go to HealthCents.com/Q1 and answer the question. There's the URL that I'm pointing to here for any that are having trouble with that. I will pause for about a minute, and while I am pausing I will pass the baton over to my colleague Ms. Susan Charkin, and this will be a good time to bring that question you have into play.
Susan: Terrific, Steve. Thank you. The first question I have is from an entity. They want to know: How can insurance companies can ask for money back for services already given when the client hasn't paid their premiums in a timely manner? Why is the burden on the provider?
Steve: Okay. Regina, would you like to jump in and provide some insights?
Regina: Yeah. Well, it's the way that the regulatory rules were written. Actually, when the regulations were being drafted and they put the rules out for comments, they did receive a lot of comments back from providers on this particular issue.
Basically, what we found in our survey and I'm sure Steve will cover this, health plans handle it differently, but in general there is a grace period. There's a grace period for nonpayment that insurance companies are prohibited, under the Affordable Care Act and the rules that were written as a result of that Act, from terminating patients immediately for nonpayment. There is a grace period.
In some cases, payers will not hold the providers responsible for providing services without payment for a period for 30 days. Sometimes it's for the entire grace period.
In any event, there is a notification requirement in place for a lot of payers, where some will issue notices to the providers that a patient is in a grace period, and they'll get that as part of their confirmation of benefits.
Interestingly, one of the things that we found is that it may take two phone calls to discover that. An authorization of benefit typically covers medical necessity. There may need to be a separate call made for verification of actual benefit and whether or not the patient is in their grace period.
Steve: Yes. To add to what Regina is saying as well, the general rule and guideline relative to the grace period rule is that, first of all, a patient is given a 30-day period before they are in this grace period of 90 days before they potentially would lose their health insurance for nonpayment. Now during that first 30 day-period, the health insurance company is actually obligated at least for 30 days of that 90-day period to continue to make the payments to the practice. However, of course, that's excluding any deductibles, coinsurance, and co-payments for that matter.
Once you get past those 30 days, the norm would be, that under the guidelines of the Affordable Care Act, that the patient then becomes responsible for payment. So it's very critical that a practice verify not just the benefits that a patient has, but also whether or not they are delinquent because you run a high risk of having to write off payments because a patient stops paying on their plan if they're in this 90-day period. You really lose the opportunity, if you will, to collect directly from the health insurance company after the first 30 days.
This is a little bit of a preview of a section we're going to cover a little further into the webinar, but it's an excellent point and that's the reason why practices potentially run a high risk of losing money on health insurance exchange patients. It's probably the single biggest land mine.
Are there any other questions, live or otherwise?
Susan: "Why is the burden on the provider for clients who don't pay during their grace period, and why do we have to return money for services already given?"
Steve: Again, that's the thing to be careful of relative to the Affordable Care Act. I'm certainly not here to advocate that I think it's a positive thing that that scenario exists. But I will tell you that the structure of the health insurance exchange guidelines is that you can collect from the health insurance company for the health insurance company's portion of the payment the first 30 days, and then for the next 60 days there is no obligation, the way the laws are written, for the health insurance companies to have to make payments to you.
Then you deal with the issue that if you don't realize the patient is not paying and they become delinquent, that it can apply retrospectively back to the beginning of the period. So it is a hazard. I'm not saying it's a positive aspect by any means of the design of the plan, but it's a reality that you should be aware of and definitely be very careful in your practice management business processes to make sure that you're verifying not only benefits but verifying patient currency on their health insurance premiums.
Now without further delay here, let's go in and take a look at how you've answered Question 1. We've had 30 responses, and we're going to go ahead and take a look at the results.
"Does your practice have patients?" It looks like most of you have said yes, in fact almost 70%, and about 16% or 17% said no, and some said "I don't know." We have almost 70% of you, not surprisingly, that do in fact have patients participating in a health insurance exchange and maybe the other 5% do or don't. We don't know for sure.
MGMA Practice Management Survey
This is a great segue into some insight gleaned from an MGMA practice management survey. One of the things that I do a lot of, besides the research that we do, is I look at research that other credible organizations have done as well.
The MGMA recently conducted a survey of about 40,000 physicians, inclusive of 42 different specialties, 75% of which are independent practices. They had several findings that I just want to reel off real quickly because it's apropos to the discussion here.
First is that practices have difficulty obtaining patient coverage information. In fact, 62% of the practices surveyed reported moderate to extreme difficulty in obtaining patient coverage information. Sixty percent indicate that the ACA exchange coverage is more difficult to verify than traditional PPO and HMO plans, while 75% say patient co-payments and patient obligations are much higher on the health insurance exchange plans than on other standard commercial plans.
Twenty percent reported concerns about narrow network designs in terms of specialists in practice and primary cares that are in network. Then 56% state that their perception is that the ACA is having an unfavorable rather than a favorable effect on their practice.
Seventy-six and a half percent say that their practice is participating in a new exchange product, and the single biggest reason for those that don't participate in managing health insurance exchange patients is the fact that the 90-day grace period, that we just alluded to, is their biggest concern. As we got asked a moment ago by the woman that participated is the fact that the burden really does rest on a practice to keep track of the delinquencies.
Eighty-seven percent say that the reimbursement is actually equal to or lower than the equivalent commercial product.
What can we put a wrap on from that kind of a study? Well, it's that the Affordable Care Act and the exchange plans are basically here to stay, and there are challenges relative to verifying and obtaining patient coverage information. There's a much greater burden on directly collecting a higher portion from patients and that you really need to be aware especially of the land mine potentially of that 90-day period, which we're going to cover again. Repetition is good here because that is a major hazard in the road.
Before I continue, do we have any other questions, either live or in our queue, Susan?
Susan: No, I think we are good to go.
Steve: Okay. For the participants, if you would like to ask a question, once again if you joined late, the way you do it is you simply press *6 on your phone. That will open up your line. You ask your question, we converse, and then when you're done, out of deference to the rest of the participants, you press *6 again and you'll be muted.
Once again, are there any questions before we continue?
ACA History
Now a little bit of background and history, and I'll go through this quickly so that we can get into some of the substantive issues about management. I think it is important to understand structurally how this whole exchange scenario is put together.
First, the Patient Protection and Affordable Care Act, the so-called ACA was put in place on March 23, 2010, when it became law. Its goal, among other things, was to provide the expansion of access to health coverage for Americans. Correspondingly, the goal ultimately was to improve the quality of care and bring down the costs.
The source of the coverage is through either state or federal exchanges, and I'll show you a little map of how that's shaking out right now. There are states that have been able, by participating in exchanges, to get a Medicaid expansion, but not all have chosen to participate and get the grants correspondingly. So we'll take a look at how that shakes out.
The exchanges launched on October of 2013. That's a little bit of how we got to where we are.
Map of Federal and State Run Exchanges
The latest map shows that basically of the states that are now participating, which are all of the states, we have essentially 16 state-based exchanges, 26 federally-facilitated exchanges, and then 3 SHOP-based, which are really small business exchanges that enable small businesses to offer benefits to their employees.
You can see the breakdown in the greenish color here for those that are state-based, and you can see the pinkish color of the federally-managed marketplaces. If you added up these numbers, you're probably wondering how come the United States now has a 51st state. I'm the first one to tell you that we've inherited a new state. No, we do not have 51 states. We count Washington, D.C. on this map. But basically that's how this shakes out.
Map of Medicaid Expansion
The Medicaid expansion decision and the way it looks, essentially as of June of this year, is that we have 27 states that are implementing expansion in 2014, including Washington, D.C., while 21 have decided at this point to not move forward, and 3 are still in open debate.
Timeline
The way the timeline rolls out is that we already had the first open enrollment period back in October 1, 2013, and I don't have to tell you all that was written at the time about the computing systems and so forth when people were trying to sign up. But eventually that got shaken out. Then the open enrollment period closed on March 31. Then it will once again open up on November 15, and this time it will go through February 15 of next year.
However, at any point in time, any participant beneficiary can enroll in Medicaid that's qualified. Coverage under the health insurance exchange products began this year, right on January 1.
Online Resources
Now I've put together a collection of online resources, and at the end of this webinar you'll be given an opportunity, at any time, to go get the PDF version of these charts yourself. So don't worry about writing all of this down here. I just want you to be aware that we've compiled a set of online resources for your benefit that you can go take a look at relative to the exchanges.
Health Insurance Exchange Consistencies
Perspective about the exchanges is that there are many consistencies across the various exchanges, and there are also many inconsistencies. I think it's an interesting way to look at the exchanges, to kind of look for where are they congruous and where are they incongruous.
Relative to consistencies, all of the exchanges, whether they're state-run or federally-run, they essentially offer the same exact categories of plans. That is you'll find catastrophic, bronze, silver, gold, and platinum across all of the different exchange plans.
You'll also find that the patient's contributions and the payer contributions are consistent. That is typically you will find on a catastrophic plan that payers who participate basically, on average, less than 60% of the payment will come from the payers, and then it goes on up to a 90% commitment on the Platinum plan.
This means that where you have a high concentration of potentially managing health insurance exchange patients, there's immediately an impact on your practice, and that is that you now have to very carefully identify those of your patients that are on an exchange plan and make sure that you are uniquely identifying the co-insurance payments that are required because they're typically going to be much higher than perhaps the usual co-payment that you get at the door and that's it. You're going to have much higher deductibles. You're going to have much higher co-insurance payments per these kinds of percentages that the payers contribute to the plans at the left end of the spectrum.
For all plans, you're also going to find a consistency that the benefits that are required at a minimum to be in the plans are pretty much the same. That is they all include prescription drugs, doctor visits, hospitalization, mental services, mammograms, preventative care, chronic disease management, and coverage for children up to age 26 on their parents' plans, etc.
So these are some of the clear consistencies in the plans.
Health Insurance Exchange Inconsistencies
However, there are a collection of inconsistencies as well. The inconsistencies we've already seen are that some states have chosen Medicaid expansion coverage, others have not. Some have chosen to run their own state-sponsored exchange. Others are federally run.
There is a wide variance we find across states about which payers actually choose to participate in a particular exchange plan. You'll see categorically I would say a lot of blue in the exchanges, but there's a lot of variance as well as far as which products and which payers are in these exchange plans.
The premiums established by the payer are highly variable, and they're all over the map. A lot is going to have to do with the pricing and the products that the payer has established. We see certain cases, for instance a large payer in Arizona, they just mirror their plans and the payment structures on the exchanges. Others have completely different products that they've built and designed specifically for the health insurance exchanges.
We also see an inconsistency that basically the benefit plans vary considerably. Again, it's the very reason why it's important to actually do that verification of benefits up front and not only verify the benefits but also verify the currency of payments so that you don't find yourself falling off a cliff and having to incur a write-off as a result of the 90-day grace period.
Also, the products that a payer chooses to offer, whether they are specific PPO product lines, HMO, or multiple products of both varieties.
The last, but not least, is the provider reimbursement associated with the exchange plans, and there is absolutely a lack of consistency here or no consistency, because we see cases where reimbursements are identical and just an extension of existing PPO agreements. We see other cases where they're much lower. Some are in the 50% to 70% range of local Medicare rates as compared to PPO plans that might be 110% to 160% of local Medicare rates. So you have to be very cognizant of the plan structure that you're dealing with because there's a considerable degree of variance.
That's a little bit about consistencies and inconsistencies. This is a good point to also ask if you might have any questions at this point in time. So I'll open up the lines again. If you'd like to ask a question, please press *6 or send info@HealthCents.com your question and we will cover it.
Reimbursement on Exchange Plans Question
Susan: Steve, I actually have a question that really rolls into the reimbursement. "Insurance companies say that medical exchanges — I guess there have been some recent articles — have resulted in higher costs. I also understand that there is no limit on the premiums that insurance companies can require employees to pay. I just got a call from one of my insurance companies and they want to decrease my rates. How can I prevent this?"
Steve: There are several aspects to this question. It's a very insightful question and thank you for asking it. As far as reimbursement on exchange plans, that is absolutely correct. There are no real regulations or consistencies. How you go about determining whether or not you're in a plan can be a little bit complicated as well. In some cases, letters were sent out in certified mail basically informing practices that they participate in an exchange, and that was done prior to January 1. I've had many practices tell us as well that they found themselves in an exchange plan not realizing it.
I think if you find yourself in an undesirable position, where you're dealing with exchange plan patients and were not appropriately notified, that would definitely be a domain for your legal counsel to deal with, because depending on the state you're in and the insurance board regulations that might not be an acceptable situation.
There are other cases where the presumption is that the reimbursement is one and the same as are the products. But even in those cases you're still going to be dealing with much higher patient payment obligation.
I'm going to show you in a moment how to go about kind of dissecting the health insurance exchange participation and how you figure out whether or not the payer is in the exchange and then correspondingly how you figure out whether or not your practice is in.
That is the backdrop. Regina, would you like to weigh in as well?
Regina: I think you've hit on the core of that. There was a kind of follow-up question about how do you prevent them from lowering your fee schedule.
There are a couple of different ways to address that when you get those types of notices. Your contract should contain a clause that discusses what constitutes material changes in the contract and when they notify you of those changes how long you have and in what form you should be responding to them. If you get a notice that your rates are being changed in a material way, particularly if they're being changed to the downside, you should immediately, or within the time frame given, respond to the payer and let them know that this is going to represent a loss to the group and you need to negotiate or renegotiate that schedule.
Steve: Yes, very important.
Susan: There are some other questions. In the interest of time, some of these questions will actually be answered as we go through the presentation. The only thing else I'd like to add is as far as getting requests for rate reductions, it's standard negotiation strategies. In other words: What is your positioning in your local area? Do you offer special services? Does the payer need you in the network more than you need them?
The same tactics that you would take for a traditional commercial payer, you can also use to negotiate potentially your exchange. That was the other thing I wanted to add as well.
Steve: Yes, and it could actually be a latent opportunity. That is by negotiating perhaps less desirable rates potentially on an exchange product, that in exchange for that perhaps you can figure out where you get the most bang for the buck on code groupings on your primary products.
Maybe it's surgical codes and E&M codes that are going to give you the most bang for the buck. So you leverage the PPO rates for surgeries and E&M codes on your commercial agreements in exchange for agreeing to participate in the exchange and kind of do a cost benefit analysis based on the volume of patients that you expect to come in through the exchange versus the core constituency of patients that you have in your primary PPO and HMO plans.
Potential Hazards to Practices
The biggest hazard in the road, the biggest ditch on the freeway potentially is grace periods. Now we have certainly touched on this, but I think wrapping it here in a focused manner is really critical because it is apropos to the very first question that we were asked a little bit earlier. It is one that invariably, as you manage more exchange patients, you're going to deal with.
That is first off the way it works is that any exchange policy holder by design . . . and again this is the point I made before. I'm not here to tell you I think this is a great design or it should be this way or whatever. It is this way.
By design, the grace period structure is that there is this 90-day grace period for monthly premium payments, and the first payment has to be paid in order for the patient to be enrolled in the plan. So they're going to make at least one payment for sure, or they never get into the plan.
However it's open kimono after that, meaning that at any point a patient or beneficiary could stop paying potentially, and at that point it becomes the first missed premium. The payers by design are prohibited from terminating coverage of benefits with the first missed premium.
So even though the patient is not paying the first missed premium, still you can get reimbursement from the payer for the first one, but it's not true on the second and third missed premium payments. At that point, basically you're stuck having to collect from the beneficiary who is now your patient who is delinquent on payments for the second and third payments.
In red here, the benefit is essentially disallowed retrospectively. I highlight that one because this means that it can go right back to the very beginning of the period.
Be very careful, when it comes to payments, to understand exactly where your patients stand relative to their payments.
The third missed premium is going to result in termination of coverage, but again the liability now for this retrospective scenario is still there, where the obligation to make the payments is still in play for the patients but at the same time your only recourse now is to collect from the patient.
This is the number one thing to look out for. The antidote to it is to not only check your patient benefit plans but determine if they are current on their payments. You have to go through that effort up front each time you're seeing an exchange patient because potentially this scenario can bite you and you don't become aware of it until later. Most payers actually — you'll see in the survey — have indicated that they will cooperate and let you know if a patient is delinquent relative to grace periods.
Other Possible Hazards to Practices
There are other hazards in the road where perhaps the ditches aren't quite as big, but they're still out there. There's the "Congratulations, you're contracted in our plan." Well how did that happen?
This is what I was saying before is that we've had many practices explain that suddenly they were in a plan at 60% of Medicare and they didn't even realize that they got into the plan. It's inexplicable how that might happen, because normally there would be a written notification based on the requirements within your state well in advance of that January 1, 2014 date. But yet there are practices that somehow got into the exchange and didn't realize it. I'm going to show you a technique in a moment if you're not sure whether or not you're in the exchange plan — I know at least some of you were in that boat, based on the survey answer — how to go about figuring that out.
There is also the tax on your staff obviously to do this additional validation on your patient benefit plans to figure out the nuances of whether or not patients are keeping up with their payments on the exchange plans.
There is the potential that rates on the exchange plans are lower than on other commercial products, and there's also the fact that a higher percentage of the collections are now going to occur from patients versus the payer. The traditional allocations of payer payments versus patient co-payments and deductibles is skewed much more, as we saw, particularly on the left side of the spectrum. With the catastrophic and bronze plans and so on, there's a lot more patient obligation in play.
Then there is the Stark in-office ancillary exceptions and other legislative requirements. What does this mean? Essentially the Stark in-office ancillary exception means that if, for example, you're a urologist or orthopedist and you're doing MRI in your office or labs and the like, that's where the Stark in-office ancillary exception would enable you to do that. But depending on the scenario, the plan, etc., it may be that the payer has outsourced these services to a third party, and even though you've incurred the cost to build up an MRI, CT Scan or lab in office, etc., now you find yourself not being able to get reimbursed. So make sure that you know what your rights are relative to reimbursement if that becomes an issue for some of the ancillary services that your practice might provide.
Navigating the Health Insurance Exchanges
A key question here, I keep saying, well, somehow you might find yourself in an exchange plan and not know it. At least five of you on this call have indicated that that already is the case. Well, here's how you figure it out.
First you can start by going to Healthcare.gov and start a basic query where you can say for you, your spouse, your children or whatever you choose in that regard to get the query going and figure out which payers offer plans in the state that you're in.
This particular query I did when the plans were rolling out. It essentially works the same way, and it comes back and tells you the exact plan. BlueEssential, it's a PPO, it's catastrophic, and here's the payment. Simplicity offers an HMO on the catastrophic scenario for $559 and so on.
So you can figure out quickly at least who is in the plan, and then you certainly will be able to map that against who you're currently contracted with. Your first clue is, "Is my payer currently showing up as a participant in the health insurance exchange?" By the way, if you're in another state, like we're here in California and you go to Healthcare.gov, as soon as it detects that you're in California, it will redirect you to the California website. The same will happen if it's another state exchange and the same kind of process is invoked when you query in your state.
Once you determine whether or not the payer is actually in the plan, then the next thing is to basically figure out whether or not your practice is then listed on the payer's site. You want to kind of take this in two chunks. You first want to figure out whether or not the payer is listed as an exchange plan participant, and then you want to figure out whether or not you're listed in the plan.
Then you go through this whole process of now figuring out what your reimbursement is relative to the exchange plan product. If it's not the same as your PPO rates — in some cases it will be and in other cases it won't — then you're going to have to contact the payer as well to get the unique fee schedule that's in place that governs the exchange product.
Prepare a Payer Exchange Participation Template
Now I've put together a tool that you're certainly welcome to use. I think it's a great way to simplify what can appear to be this daunting, complex maze of figuring out exactly where you stand relative to health insurance exchanges. Working with a variety of practices and looking at the key attributes of the exchange products, we came up with a simple template that you can use directly. You can literally copy this template into an Excel spreadsheet and replicate it.
What you do is you list your payers as Payer A, B, C, D or Payer 1,2,3,4 or whatever. You figure out which exchange plans they're offering and what the categories are. You figure out what products they're offering and how they map to the exchange plans and the eligibility check. Do you check their cards? Do you check a website? How do you do it? You figure out which hospitals they're in, the ancillary services and the out-of-state coverage.
By the way, this is another potential "gotcha." I will tell you personally when I was looking for health insurance with my family, back in the November time frame of last year, one of the things I noticed is that some of the big payers here in the State of California don't really provide out-of-state coverage, which kind of blew me away. I'm talking big-named payers, including the top three payers.
All they do is when you're out of state and if you have a health issue, the only thing they'll cover is emergency room services. If you travel from California to New York and you get a gall bladder operation unexpectedly in New York, well your emergency room fee will be covered, but the actual gall bladder operation in that scenario would not be covered because there isn't any out-of-state coverage for that service.
So you have to be very careful to also understand the in versus out of state. It seems like that isn't totally prevalent, but we're seeing it in as many as 15% to 20% of the cases that we see anecdotally. That's why I marked it red.
You want to look at the grace period and how it's managed.
Is the reimbursement the same or different than the payer's standard products, and are you automatically enrolled or not?
You can pretty much then traffic light each of these cells and then hone in on any of the red cells. For example, in Payer 3, the reimbursement is at 60% of local Medicare rates and somehow we ended up in an automatic enrollment and found ourselves in the plan. That's a red flag. We need to understand how that happened, did it happen legitimately, and go deal with that immediately.
I would encourage the use of this kind of template, if you don't already have something similar, to really map out where you stand on each and every payer. Do the investigation by starting with the Healthcare.gov site, get out to your payer site, figure out if you're listed at the payer site as a provider in the specialty that you're in or as a primary care provider, and go from there.
This is a good point to pause once more. Do we have any questions at this point, Susan?
Payment and Benefit Questions
Susan: Yes, we've got about half a dozen of them, and a number of them go back to payments. In other words, "If benefits are disallowed or not paid, can I collect credit cards up front when I first see the patients to make sure I get paid?"
Steve: I'm sorry, we're losing you. You are coming across a little garble.
Susan: That's okay. Basically I got about half a dozen questions, and most of them are regarding delinquent payments. For example, people want to know, "Can I collect credit cards up front when we first see the patients to make sure that we get paid and then refund them if they do get paid by the insurance company?"
The second thing is: How do they get benefit information? In other words, do they have to sit on the phone and call for every patient and wait to talk to a rep? Is there an electronic way that they can get the information that they need?
Steve: It's interesting that these are two questions that we hit on in our survey shortly too. There are really two pieces to this. Can you offset your risk essentially by collecting the fee from the patient in total and then give it back when you get it back from the payer? I think that's the essence of that one. Then the second one is: How do we verify their benefits exactly? Do we have to sit on the phone or do it some other way? Let's take them in two pieces.
First off, "Can we collect up front from the patients to offset our risk?" The general answer to that unequivocally is, "No you can't." What you can do is you can collect the coinsurance payment and any payment that is legitimately a part of the patient's plan. That is if they have a deductible of $10,000 before the payer kicks in money, then of course you can collect up to that $10,000 as a deductible from the patient.
Beyond the patient obligation, you cannot legitimately and I'll go as far to say legally, even though I'm not an attorney, the reality is you cannot collect payer obligations from a patient. You can only collect patient obligations. You can certainly collect those obligations up front from the patient, but you cannot collect additional monies from a patient because you're concerned that the payer may or may not come through with its payments. You can't use the patient as an insurance policy, if you will, against the payer. It's just not allowed.
Second one, how do you verify the benefits? Well, this can be a bit of blocking and tackling. In some cases, you can look at the card. For example, the Blues have various suitcase icons that are meaningful that will tell you what kind of a PPO plan the patients are participating in.
Beyond that, if you're not sure, then some payers work off websites, where you do the verification off a website. Others work off the not-so-fun-to-deal-with customer service 800 numbers.
One way or the other, while it's frustrating sometimes to deal with that and the time it may take to get that verification done, there is a return on investment because if you don't do it — like we talked about — you risk the potential for finding out later that the payer doesn't have an obligation to make certain payments.
Regina: I'll just pipe in here. I helped conduct the survey. When we were talking to the payers, in some cases they said that when you're getting authorization — again I want to go back to what I said before — that typically deals with medical necessity. Anybody who has received an authorization has probably seen that big, bold block of lettering in the middle that says "Authorization of services does not guarantee payment."
The other step in the process is verifying benefits. Typically, when you call to verify benefits or find out what kind of plan the patient is on or what their co-payments are if it's not printed on their card, there's a number to call to verify their benefit. That's when you want to add the question if you're not already asking it, "Is this patient in their grace period?" That way, you may be able to have a way to red flag it in your own internal system to watch those EOBs as they come in or make those a priority EOB review when they come in because that's how you're going to know over time if they're continuing to make their payments on their plan.
You'll get communication from the payer if they fall off that says, "The patient's plan has been terminated due to nonpayment, and by the way, we're taking back the payments," if this is the case. If it's the case where it ends up that they didn't pay from the beginning, they'll say, "By the way, we're asking for a refund because they never paid us, and you need to go after them." It's an unfortunate situation that the providers are in, but that's the way that the regulations are written. As far as I know that's the only way to manage the process right now given what you guys have available.
Steve: Okay, good. Thank you, Regina, and thank you, Susan. If anybody on the line would like to contribute to this part of the discussion, please press *6 on your phone and go ahead and pipe in.
Craig: Hi, my name is Craig Wells from Houston, and I work for ITE.
Steve: Hi Craig. How are you?
Craig: Good. I know one thing that is really difficult is trying to verify benefits since the State of Texas is a federal exchange. The information on those federal exchanges just doesn't filter down very well. That's been our experience, and you can't always rely on what information you're getting, whether it's accurate or whether it's timely either one. Any comments or any ideas on that?
Regina: When I was talking to some of the payers, and I'm actually talking to practices that we work with, that is a problem. In states, you don't see that kind of issue so much. There may be some, but not as much. It's not as prevalent in states that have their own exchanges, the states that set up their own exchanges. For example, California, Colorado, and I think Florida has their own exchange and there are others. Steve mentioned them earlier on in his presentation. You don't see that so much.
So it is more difficult, and we're hearing this from practices and from other payers that it is more difficult to get that verification in federally run exchanges. Oddly enough, the payers are having trouble getting the backend information as well on the federally run exchanges.
It is a problem, but I haven't seen any fix or any way to navigate it other than just being diligent and every month going back to verify that the patient is still — especially if it's an ongoing treatment situation — covered by that plan.
Steve: Thank you, Regina and thanks for the question, Craig.
Value-Based Contracting
Now a word about value-based contracting. I put this chart in here because I'd say more and more the notion of adding a component of physician reimbursement that is value-based is manifesting in payer contracts, meaning that typically now we're seeing large agreements with about 95% of the reimbursement. It's still fee-for-service based, but as much as 5% potentially is value-based or performance-based.
Some of these structures have the payouts quarterly and some annually. But fundamentally they're all similar in this regard, that they have efficiency, qualitative, and quantitative metrics and correspondingly each category rewards you a certain percentage by achieving a certain number of points in that category.
The kinds of things that you see are the ones listed here. Maybe it's a certain percentage of generic drug utilization, preferred drug utilization, or proving that you follow a set of best practices guidelines. It could even be reduced hospital readmissions, active e-prescribe.
In network only referrals, that's a big one. We're seeing a big trend. In fact, it's caused attention in certain practices where the physicians may be out of network in a payer's network but the ambulatory surgery center is in network or vice versa, and it's very hard then to essentially get the other contracted because there's an in network only policy.
The payer has a patient satisfaction survey.
These were all the kinds of components that exist in a value-based structure, which is often a 5% reward.
We've seen an acceleration definitely since the rollout of the Affordable Care Act. There is a lot of speculation that potentially plans will move much more toward capitated types of agreements. We haven't really seen that as much. I mean, there certainly have always been HMO agreements, IPAs and so forth that are like that, but we really haven't seen a broad change that way. But we are seeing a broad change relative to the introduction of the value-based contracting component.
Health Exchange Reimbursement Question
Here we go with Question 2. We'll kind of do these next two back to back just so we can glean some results. I'd like you to please read this question, I'll read it with you, and then go to HealthCents.com/Q2 to answer it. Essentially what we're trying to determine here is for those of you that are managing patients in health insurance exchanges, whether or not you're seeing rates that are somehow higher than commercial plans. If we have any of those, I'd be interested to discuss that. Are they the same as your commercial rates, less than, or you just don't know?
We're just trying to get kind of a rough landscape, among those that are in this call, unscientifically whether or not your rates are better, worse, or the same as your commercial plans for the health insurance exchange plans that your patients participate in.
With that, just go to HealthCents.com/Q2 and then we'll take a look at the results. I'll give you about 30 seconds to a minute for that and also ask Susan maybe to put out another question while we're doing that.
Enrollment as a medical exchange provider and credentialing process questions
Susan: Sure. Thanks. There was a general question of: "How do we get enrolled as a provider of the medical exchange policies? There are so many. Is there a way to determine in a particular state which ones are best, and also how do we speed up the credentialing process?" It takes months and months, and they want to know what they can do to start enrolling.
Steve: Okay. So how do we get in, and how do we speed up credentialing? Regina, you've been dealing with both of those issues directly. Why don't you pipe in on it?
Regina: Sure. Steve touched on this earlier, but getting into the network there are a couple different ways. One could be the administrative add, where you get it by surprise. "Surprise, you're in the network."
In other cases, if you're currently a contracted provider, they might send you an amendment to your existing contract to add those plans. In other cases, you have to go in and request them. Again, going back to the point that Steve made about making sure that you understand what the reimbursement is going to be in each of those plans.
If you're asking about participation, they should be transparent in letting you know what the reimbursement for the plan is. In some cases, as Steve mentioned, it's going to be less than your standard commercial rates off of the exchange for plans sold off of the exchange. In other cases, it's the same exact fee schedule. So you just have to ask that question.
If you're interested and getting a lot of referrals or a lot of inquiries about services from your practice from patients who are covered on exchange plans, then it might be worth it to go and check that out, at least to find out if it's a good business decision for your practice to join that exchange once you understand what the reimbursement structure is.
With regard to credentialing, my best advice on credentialing and speeding up the process is to make sure that you submit . . . and this may sound elementary, but I've seen this become an issue. Make sure that you're submitting complete and up-to-date packages and that you're providing all of the supporting documentation that the payer is requesting.
Some payers have committees that meet once a month or once every other month. The best way to navigate that process is to make sure that they have everything they need, that everything is complete, that it's accurate, that all of the supporting documentation is up to date and nothing will have expired. Then respond to any inquiries for additional information.
I'm not sure, given this group, if we have any providers who have offices in multiple states, but in some cases payers will require that you have an NPI number, a license, and in some cases a Medicare certification for each office if it's in a different state. So keep those things in mind.
Where you can find out the best information for credentialing, most payers have credentialing information on their websites or frequently asked questions about credentialing on their websites. Definitely, if you have questions about what's required, contact the payer credentialing departments and/or view the website to see if you can find the answer to your question there.
Steve: Thank you, Regina.
Changes to exchanges in 2015 question
Regina: Susan sent me an additional questions. "Are there going to be any changes to the exchanges in 2015? What can be expected? What can we address, and where can we find information? Are there any government updates?"
What I have found to be true is that the local news is pretty good about this. They're kind of staying on top of this because it's a community interest story or a business story. So local news could be your first actual tip that there might be changes to the exchanges coming.
I don't know of any particular changes to the exchange policies or to the exchange plans that are going to roll out in 2015. There are new mandates for coverage that are going to be starting up next year, in 2015. Certain things are going to have to be covered and provided for in 2015.
I check government websites and the government reporting sites for changes to the rollout and regulations on the healthcare law itself. We might be able to send out to the participants of this meeting some links to some of the common places that we check. Steve, I'm not sure about that, but it might be something that we could make available to them.
Steve: Yeah and that's a good idea. At the end of the session I'm going to explain a very simple way to go about getting the PDF version of these charts, and to the extent that we can add some of the information resources, we can make those available through exactly the same mechanism. Yeah, let's cover that at the end.
Okay, so moving on here relative to the question we just asked, I think the most interesting outcome in the answer is that one of you has indicated that you actually get more than on your commercial plans. I don't know if you're comfortable talking about that here, but that's definitely a rarity. It would be helpful to share that experience real quick if you don't mind piping in by pressing *6 on your phone. If you prefer not to do that, that's okay, but I thought I'd offer that opportunity.
Okay, opportunity denied. I understand.
Participant: Hi. This is the person in question.
Steve: Oh, okay. Can you tell us who you are, or would rather stay anonymous?
Participant: I am a family medicine physician in California. I think I am getting paid a little bit better by the exchange. I'm only really taking Blue Cross exchange patients, Silver Plan or better. I think the reimbursement is a tiny bit better than my straight Blue Cross.
Steve: Did you do something deliberate to make that happen, or how did it come about?
Participant: I was brave and I took these patients. I figured the only way to find out what the reimbursement is, is to actually see patients. I think for primary care in my area that is what the other primary care doctors are being paid as well. We don't ask any questions about why that is. We're in technically a fairly underserved area, so that might play into it. But I didn't get any formal notice that I was going to be paid better than my regular Blue Cross plans.
Steve: Okay. Thank you for sharing. It's definitely an anomaly and a positive one for you.
As you can see here, we have a predominant number saying that they get less and some saying they get the same. I'd say that the broader outcomes generally parallel what you're seeing here in the blue and orangish bars.
Participant: It's a slight amount more. It's a few percentage points higher, I think.
Steve: Okay, good. Thank you for sharing that as well.
There is still a lot of ground to cover, so I'm going to plow through a little bit here so that you get the benefit of the payer survey as well.
Health Exchange Reimbursement Question
Basically, to optimize the time, if you'd like, either during or after the session, to answer Q3, that's fine. Basically, the question was designed to determine whether or not you wrestle with more issues relative to claims processing on exchange patients versus commercial and HMO plans. I don't think I'm going far out on a limb, based on the discussion up to this point, to say that I think we've collectively identified the additional complexities of claims verification, higher deductibles, co-payments, etc. to know that there are those kinds of issues to wrestle with.
Health Insurance Exchange Payer Survey
For the Health Insurance Exchange Payer Survey, briefly the background here is we went out ourselves and surveyed 13 payers in 10 states and asked them 10 specific questions. I've listed the states here. We simply chose a cross section of states, representative of different geographies in the country, to just put together a composite view of what these payers are telling us relative to these 10 questions so that we could lend insight to practices like yours for your benefit.
All payers' names were kept confidential to protect the innocent or guilty, depending on how you might look at it. All were large and many certainly were "Blue." The goal was to find patterns that might exist across the geographies to lend insight.
We did the survey directly with those payers online ourselves. Regina, in fact, did many of these surveys directly as did her staff. One payer actually submitted the survey anonymously as well, much as you have real time on the two questions that we asked.
If you'd like to discuss beyond what I'm going to cover in the next five to 10 minutes and get more details about the survey, feel free to follow up with us. Our contact information is at the end.
Now for the actual survey, I'm going to take you through a quick run here and try to point out the salient points as we go.
Payer Exchange Survey Question 1
How do we know if a provider or patient is in an exchange plan? We've already identified scenarios where sometimes they show up and you don't know, but the most common comments that we got is that you need to essentially validate the patient's card and their benefit plan or go to the website and basically be aware of the deductibles, the co-payments and coinsurance, and whether or not your practice is enrolled in the exchange plans.
Payer Exchange Survey Question 2
Question 2 was all about grace periods. We were trying to assess whether the payers had practices that were consistent with or inconsistent with the grace periods. Generally, although the distribution was basically the patient would be covered up to 90 days and other, we found that for the most part the intention of the payers' answers, as we drilled into it, is that they were fairly consistent in that. As we discussed about the grace period ruling, for the most part the payers basically said that after the first 30 days of delinquency that the burden is on the practice to collect from the patients.
There were a couple of unique scenarios where the payer actually provided coverage beyond the 30 days. That was certainly the anomaly and not the norm.
So I think the takeaway here is by and large the answer to the question here validated what we've discussed here relative to grace periods, which is the first 30 days you still have the ability to go back and get the payment from the payer. The next 60 days it's on the patient, and there is that retrospective notion that once the patient is out of the plan, then it goes back to the date that they were delinquent.
Payer Exchange Survey Question 3
Question 3: From the date that a service is billed, what is the maximum time the payer has to pay?
There was a lot of variance here. Most were in 30 days. Some were other. Some were 120 days. But basically it's based on the provider's agreement and state guidelines. You want to make sure, if you're seeing a pattern where claims are not being paid timely, to go back and check the guidelines with your insurance commission to make sure that you are being paid according to the guidelines in your state.
While I'm plowing through the rest of these answers, I also want to remind folks for the duration of the call if you'd like to ask additional questions, please send your questions to info@HealthCents.com. If, due to the structure of time left here we don't get to answer your question, we will follow up after the session as well.
Payer Exchange Survey Question 4
Question 4: If a provider is non par, that is they're not participating in the exchange, can you collect up to 100% of the billed charges when you provide services?
The short answer here is yes, you can. The same rules in essence apply to being non par relative to an exchange product as they do relative to being in a PPO or HMO product.
The only difference is you may find that the burden of payment is higher relative to the amount that you're going to need to collect from a patient. Some payers have higher payments on their PPO plans that would provide at least 30% to 40% of the payment still coming from the payer out of network. That's 30% to 40% of the billed charges in some cases.
In the scenario of the exchange products, you can certainly collect at your billed charge or at a 20% discount off billed charges, but you're going to have to, again, be cognizant of how much you're going to need to collect from the patient versus the provider.
Payer Exchange Survey Question 5
Question 5: Can an exchange patient's credit card be pre-charged?
I think we were asked this question a little bit earlier. It's worth emphasizing that yes, it can be pre-charged, but only for the patient's portion of the charges.
For a 99213 office visit, if it's $100 and the patient obligation is $25, you can't charge the patient $100 and cover that $75 payer obligation. That is not allowed. You can only charge the $25 patient obligation.
Be very careful of that. That could get you into a lot of trouble. Certainly if you're thinking of doing that, I'd highly recommend checking with legal counsel before invoking any kind of a practice along those lines.
Payer Exchange Survey Question 6
Where is information available about exchanges and benefit eligibility?
Websites, patients' cards, provider relations, and sometimes it is a slog. I mean, it's hard to get answers. In some of these surveys we've had payers tell us after being on the phone for half an hour with three different contacts that they didn't even know who we should talk to at the payer organization. Obviously, we have a lot of skill in navigating both provider relations and contract management departments, so we definitely feel your pain there.
Payer Exchange Survey Question 7
Are there any unique coding and/or billing requirements for the exchange products?
This is one of the rare cases where it's unanimous. There really aren't any unique requirements. The same coding and billing methodologies apply to exchange products as well as to traditional PPO and HMO products.
Payer Exchange Survey Question 8
Are any of your exchange products risk based HMO products? Risk based in this case meaning capitated, per-member per-month fees.
I would say the answers that we saw here for the most part mirror what we see in the marketplace. Most plans still are PPO plans. There are HMO plans usually as part of integrated ACOs, IPAs, or hospital-based kinds of agreements.
We're not necessarily seeing any kind of a radical shift in a movement — at this point anyway — away from fee-for-service structures into capitated. What we are seeing, as mentioned before, is the performance valued-based component coming into play both in the commercial agreements as well as the exchange based products. That's in keeping with some of the goals of the Affordable Care Act.
Payer Exchange Survey Question 9
Now this one here, again, is a big "got you" if you have the rare case where it applies. In this case, it only applied in a little under 8% of the cases, but this is where we mentioned that some patients basically find themselves in a situation where they're insured in one state, they travel across state boundaries, they get sick and go to the hospital and the only thing covered is ER benefits because they're no longer in the state boundaries.
Make sure that if you're servicing a patient in that scenario, you at least understand that risk if they happen to be on one of those plans where the coverage doesn't extend beyond emergency room coverage relative to treatment out of state.
Payer Exchange Survey Question 10
The number 10: Are there any unique requirements for ancillary services in your exchange based products?
For the most part the answer was no here. They thought they followed the same guidelines that they follow for ancillary networks.
The caution here is this is sometimes problematic for practices that are looking to grow their ancillary services. We have urologists, for example, that do IMRT, MRI, labs, and so forth. If a payer has a third-party agreement with an ancillary provider that requires using that ancillary provider, then you can have a large number of claims and a large number of write-offs as a result of those claims for ancillary services.
Health Insurance Exchange Payer Survey: Summary
What did we learn from the health insurance payer survey?
Again, there are lots of "Blue" payers out there that do participate. There's lots of variance across the exchanges relative to reimbursement and benefit plans and coverage.
It's important to know exactly how the patients in the specific exchange networks correspond to the exchange plan reimbursement.
You need to persevere. It's not always as easy as just picking up the phone and talking to the first person to get your answers relative to in network participation, benefit plans, etc. You might have to spend half a day or a day or more to get to the right people.
If you want more details about this survey or any of the information contained herein, I'm glad to provide it.
Now, how do you put this information to work?
How do you put it to work? The single point that I'd like you to take away that's most important here is to be careful to leverage and check the benefit plans of each of your patients and also be aware of your position in the marketplace relative to your payer contracts and being able to actually leverage reimbursement on your traditional commercial products and use the exchange plans as an opportunity potentially to do that.
How to redeem your discount
Quill.com Healthcare is very pleased to thank you for your participation in this session today by offering you a discount on medical supplies. The way you redeem this offer is by going to www.Quill.com/medicalsupplies. For $50 or more, you get a $15 discount, and if you spend $100 or more, you get a $30 discount.
Further Information
The parting points here, relative to getting the slides and further information is to contact Quill Healthcare. The 800 number is here. If you'd like to reach out to the panel of speakers today, you're welcome to send an email to info@HealthCents.com, and we'll immediately receive it.
If you would like a PDF copy of this presentation, all you need to do is send an email to Charts@HealthCents.com, and we will basically immediately distribute the charts.
What we will also do over the next 24 to 48 hours is for those of you that asked questions that we didn't have the opportunity to answer in this session due to the time frame allotted, what we will do for you as well is if you wait until Monday morning at the latest and email Charts@HealthCents.com at that time, it will feed back to you not only a copy of the directions on how to get a copy of the PDF charts, but we will have cataloged the questions and answers for those questions and answers that we didn't have an opportunity to cover here in the session. Send a simple email to Charts@HealthCents.com, and we'll get your answers to questions and get your charts.
Questions/Comments
We do have a couple of minutes here allotted for wrap-up and I'd like pause one more time, invite you to press *6 to ask any questions and also check with my colleague Susan to see if there are any others that you would like to cover here before we conclude.
Susan: Yeah, we had a whole bunch of questions, unfortunately, and we apologize that we're just not going to get to. This is a consistent theme here and I think we've answered this already. "Are there any special or unique requirements for medical exchange patients with regards to meaningful use, HIPAA, or EHR that are different than what we currently do for Medicare and our HMO and PPO products?"
Steve: I'm not aware of any offhand. Are you aware of any, Regina?
Regina: No, I'm not. In fact, when we surveyed the payers, the ones that we spoke with said that administratively on that end of it there would be no difference.
Steve: Okay. Somebody asked a question?
Participant: Yes, a quick question on getting the PDF copies. I'm not hearing the email address correctly. Can you just spell out the email that you want for us to request the PDF?
Steve: Yes. For those of you that don't have the web portion up, it's Charts@HealthCents.com. Email and it will come right back.
Participant: Thank you very much.
Conclusion
Steve: I want to remind you again that this is the first in a series of these value-add webinars for Quill.com customers and for customers who were looking to buy products from Quill.com Healthcare. We hope that you found the information here to be very useful to your practice and that you put it to work immediately. We're more than happy to carry on this dialog with you in more detail following the session based on the contact information provided.
Once again, we thank you all for your participation in Quill.com Healthcare's first value-add webinar and we look forward to future sessions. Thank you very much today for your participation. This concludes today's conference.
