ACA exchanges creating new administrative headaches for practices

May 21, 2014

Physicians are facing a new set of administrative challenges for ACA exchange patients, ranging from verifying coverage to coping with narrow networks.

Seven months after the startup of the Affordable Care Act’s (ACA) health insurance exchanges, medical practices have yet to see a major influx of new patients, but are still facing a new set of administrative challenges, ranging from verifying coverage to coping with narrow networks.

Those are among the conclusions to emerge from a recent survey of medical practices conducted by the Medical Group Management Association (MGMA) on the effects of the exchange implementation. 

The survey included about 700 medical groups across the county with more than 40,000 practicing physicians. It found that:

  • More than 90% of respondents had seen patients with insurance coverage obtained through an exchange plan

  • 56% of practices had seen no change in the size of their patient population through the end of April, with another 24% reporting a slight increase

  • More than half of respondents are finding it more difficult to verify patient eligibility, obtain cost-sharing information, and obtain information about other in-network providers from exchange plans compared with traditional commercial coverage. About one-third of respondents reported no difference in difficulty

“Physician group practices are expressing dissatisfaction with the complexity and lack of information associated with insurance products sold on ACA exchanges,” Susan Turney, MD, MS, FACP, FACMPE, MGMA president and chief executive officer said in a written statement. “Even though there hasn’t been a huge influx of patients into physician offices as many predicted, simple tasks such as obtaining patient insurance coverage information or finding specialists for in-network referrals have proven to be significant challenges.”

To-date about eight million people have obtained coverage through the ACA exchanges. Approximately three million more enrolled in Medicaid or the Children’s Health Insurance Program between October, 2013 and April, 2014 according to the Centers for Medicare and Medicaid Services.

Other findings from the MGMA survey:

  • More than 80% of respondents said that payments rates offered by ACA exchange insurers are equal to or less than average payment rates from all traditional commercial insurance contracts, and from traditional commercial products offered by the same payer(s)

  • 75% of respondents said it was “very” or “extremely” likely that, on average, patients with ACA exchange coverage would have high deductibles compared with patients with traditional commercial insurance coverage

  • 41% of respondents have seen patients to whom they could not provide covered services because their practice was not included in the exchange product’s network

  • 23.5% of respondents are not accepting insurance plans sold through an ACA exchange. Among those, the most common reason cited (48%) was concern about assuming financial liability for patients during the 90-day grace period for ACA enrollees, followed by the practice not being asked to participate by payers (42%)