As Congress debates its replacement for ACA, we can all appreciate the enormity of trying to balance sustainable benefits for Americans while reducing the financial burden of providing those benefits. And while there was much uncertainty surrounding the American Health Care Act of 2017 (“AHCA”), it seems that our leaders are intent on keeping a very important provision of PPACA – “Patient Protections.”
Many people seem to have forgotten ACA is actually called the Patient Protection and Affordable Care Act. Although the Affordable Care provisions of ACA were controversial, there was hardly any objection to the Patient Protection provisions of ACA. Much of the Patient Protections provided under ACA clarified and augmented many of the protections already in existence under ERISA. With little controversy and near universal acceptance, Patient Protections will continue to be law of the land, so it is time every healthcare provider incorporate these Protections into their business.
Patient Protections are great tools for healthcare providers to fight for fair reimbursements and fight off recoupments. Because of protections under federal law, patients have much more leverage against insurers than healthcare providers have. Acting on behalf of the patient, a provider can add a new level to its revenue cycle and fight off unjustified recoupment. Hiring an experience professional to incorporate Patient Protections in your practice is critical. As the recent 9th Circuit Court decision in DB Healthcare LLC v. Blue Cross Blue Shield of Arizona shows, success against insurers is unlikely unless you have a Patient Protection professional help with all of the important details.