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    ACA’s ‘grace period’ shows physician-led reform must be grassroots

    Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or [email protected] for more information.

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    As policymakers pieced together what would become the Patient Protection and Affordable Care Act ("Obamacare") in 2009, a Gallup poll asked Americans who they trusted to recommend the right reforms for the U.S. health system.

    More than anyone else, those polled declared that physicians could be counted on to guide health reform.

    Five years later, we know that physicians' recommendations were mostly ignored, while insurance company executives, bureaucrats, and academics re-engineered the health care system in a way that fails to consider the realities of medical practice.

    Case in point: The 90-day "grace period" for patients who fail to pay their ACA-supported insurance premiums in full.

    Throughout the construction and early rollout of the ACA, health insurers were responsible for unpaid claims incurred throughout the entire grace period. The Centers for Medicare & Medicaid Services (CMS), however, slyly shifted insurers' exposure for the full 3 months in regulations. As of today, issuers must pay claims incurred during the first month of the grace period only, and they're not obligated to inform providers of patients' nonpayment status until months two and three.

    More than 80 physician organizations representing physicians and medical practices voiced indignation in a March 2014 letter to CMS Administrator Marilyn Tavenner.

    "The timing and manner of such notice is left to the discretion of the issuers," the letter noted. "We believe these current notice requirements are inadequate and will lead to administrative confusion for physicians and practices."

    Continue to the next page for more.

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