The presidential election is over. The Supreme Court has ruled. The Affordable Care Act (ACA) is here to stay. For practices, that means preparing for the many provisions and new regulations that haven’t yet taken effect. Those likely to hold the most immediate impact include:
- Operating Rules. The transition to 5010 essentially marked the first in a series of Operating Rules that promise to standardize and simplify electronic healthcare transactions over the next few years. Starting January 1, 2013, the ACA Eligibility and Claim Status Operating Rules will mandate standardized payer responses to information requests. These rules should help decrease the number of claims denials practices receive because of erroneous eligibility information.
- Reimbursement reform. Accountable Care Organizations (ACOs) and bundled payments will both become more prominent in the coming months, as payers try to offer incentives for working together and sharing accountability for patient care cost and quality.
- Clinical quality measurement. New and expanded reporting criteria for clinical quality measures (CQMs) will take effect in 2014. Practices should start to consider the role that clinical analytics tools can play in helping to accurately and efficiently report CQMs for their patient populations
- Health plan exchanges. Also starting in 2014, individuals and small businesses will be able to purchase insurance directly through insurance exchanges. To make it easier to compare the different levels of coverage available, insurance plans will be placed into tiers such as bronze, silver, gold and platinum. Practices should become familiar with both the exchanges and their products—what they are, what they involve, and how they are accredited.
The ACA is moving forward. For reference, you may want to check out an ACA timeline on the U.S. Department of Health and Human Services website.