The Affordable Health Care Act Explained: Part 2a – Big News for Medical Billing Professionals

Perhaps no legislation in American history has brought more angst and anger among the people as the Affordable Health Care Act, affectionately known as Obamacare in some circles.  Regardless of how a person feels about this act from a political standpoint, the Act has become law and is supported by the U.S. Supreme Court.  This Act was staunchly opposed by Insurance carriers nationwide and the opening paragraphs reveal why.

After dispensing with the necessary legalese corrections to the Public health Service Act (42 U.S.C. 300gg) Part A-Individual and Group Market Reforms adds Subpart II—Improving coverage.  This addition is especially important to anyone who performs medical billing because it terminates lifetime benefit limits and changes the limits to annual amounts radically.

Here is what every Medical Billing professional needs to know:

  1. Effective September 23, 2010, no policy may carry lifetime limits.  If a carrier attempts to avoid paying by claiming the beneficiary has reached their lifetime benefit limit, they are breaking the law.  This also means that more people will be covered for longer, which translates into more business for your clients and you.
  2. Annual dollar limits will be phased out.  Phase one is over, the nation is currently in phase two, phase three takes effect September 23, 2012, and the final phase takes effect January 1, 2014.  Details are as follows…
    • Phase Two, effective September 2011, raised the annual limit to $1.25 million.
    • Phase Three, effective September 23, 2012 raises the annual limit to $2 million for a plan or policy beginning after that date but before January 1, 2014.
    • Phase Four, effective January 1, 2014, removes annual limits entirely—sort of.
  3. Limits may still be placed on services that are not considered “essential.”
  4. The rules apply according to when someone starts a new plan or renews.
  5. The annual dollar limits do not apply to policies ‘grandfathered’ in.  ‘Grandfathered’ applies only to plans that are purchased outside of an employer group plan; that is, purchased privately by individuals; and purchased prior to March 23, 2010.
  6. The lifetime ban applies to ALL plans.

We know that you will find this information useful in your medical billing practice.  Many find the Affordable Health Care Act confusing and we here at American Business Systems believe in helping in every way we can.

In our next installment, we will discuss the next part of the Act, limits to specific benefits that are not “essential” (as mentioned in number 3 above).

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