How to handle the transition to fully covered preventive care

While many parts of the Patient Protection and Affordable Care Act, signed in March, won't take effect until 2013 or so, the new preventive health requirements begin to kick in for some nongrandfathered health plans in January 2011. A recent American Medical News article outlined the top implications these benefit changes will have for your practice.

For starters, collections will become more complicated for staff, as some patients will be 100 percent covered for recommended preventive care, while those with grandfathered plans (defined as those that have not changed significantly since the health reform bill was signed) will--for the time being--still be required to pay copays and coinsurance. This means that staff will not only have to determine the status of each patient's health plan, but in many cases also educate the patient about what qualifies as a preventive service for that specialty. After the initial transition, this process is expected to become easier as more plans lose their grandfathered status.

Patients will also need to understand that even if a preventive service, such as a cholesterol screening, is completely covered, they'll still be responsible for cost-sharing related to the treatment of any identified problems. To address this issue, Rockwood Clinic in Spokane, Wash., recently began handing out information sheets explaining to patients that if a problem-oriented service is provided during a preventive visit, the appropriate charge will be assessed.

Finally, there's a strong possibility that demand will increase sharply for fully covered preventive services, leading experts to recommend practices rethink their scheduling strategies. For instance, consider focusing on sick visits on Mondays and filling the slower mid-week days with more preventive services.

Although the interim final rule called for the preventive services requirement to begin on the six-month anniversary of the health law's signing, more guidance is expected from the federal government on how this part of health system reform should be implemented, amednews reports.

To learn more:
- read the story in American Medical News
- see this Manage My Practice post about covered Medicare services in 2011

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