what’s happening with what’s called the One Big Beautiful Bill So let’s go to the slides.
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Hey there. Greetings, friends and colleagues. This is Sam Collins, the coding and billing expert for chiropractic and acupuncture. We’re combining today a little bit because we’re gonna work talking about chiropractic and acupuncture combined on what’s going on or what you’re gonna be looking forward to, if you will, with what’s happening with what’s called the One Big Beautiful Bill So let’s go to the slides.
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Let’s talk about that to make sure everyone has a good understanding. The reason why I want to bring this up now is I’ve recently gotten a lot of questions from my network members and others asking, “Hey, Sam, how is this going to affect me?” And I wanna be- make sure that we’re being proactive and not reactive to what’s going on.
So what is this One Big Beautiful Bill Act? How’s it going to affect us? What makes a difference to us? Really what the One Big Beautiful Bill Act is, as related to healthcare providers, are the changes affecting healthcare insurance, if you will, whether it’s gonna be through Medicaid or through the exchange.
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So it’s more so gonna be an effect on the workflow that you have to do in tightening up are they insured or are they not. So the impact for providers is gonna be about insurance verification. This is really going to be mostly about people with marketplace plans. That’s the one they get through the marketplace.
Many people have them. And of course, anyone through Medicaid. Now, remember for California providers, we call that Medi-Cal, but it’s one in the same. It’s gonna really make a difference because, as you’ve probably noticed in the news, it’s gonna change eligibility. So it’s gonna require much more frequent verifications, and there’s gonna be some retroactive issues with it as well that someone may appear to be active, and then it’s taken away.
So here’s really what I wanna make sure. What if you say, “Hey, Sam, I don’t do a lot of Medicaid or none at all. I do mostly cash.” Then this doesn’t affect you at all. But if you’re dealing with people in the marketplace or Medicaid, it does. So most healthcare offices will have minimal effect unless you’re treating those types of patients.
So keep in mind, a lot of times when you’re hearing a lot of this hyperbole in messages, it often gets you panicked, thinking, “What do I need to do right now?” That’s why I say slow down and let’s look at it. Here it’s gonna be the Medicaid one. So it’s primarily on coverage, and let’s make sure too that I’ve seen some things about this that people say it’s gonna change how you bill.
It is not gonna change how you send a claim. It only impacts the coverage itself. So it’s not gonna impact coding or how claims are submitted, but primary coverage eligibility. So we’re gonna have to put a lot more pressure on us and the patient to what is or is not gonna be covered. This is really gonna begin next January, but I think it’s best to start getting used to now following through to make sure, does my system work through it?
Whether you’re using a Vality or something through your clearing house, you wanna have somewhere that can easily verify what’s going on with a patient because you’re gonna have to make sure that these people are still eligible. Why? There’s gonna be changes to eligibility. As you’ve probably heard in the news again, there’s gonna be eligibility changes based upon is the person able-bodied and working?
Are they doing volunteer service? So there’s gonna be a lot more verification. I think a lot of people will lose their plan, gain it back, and you’ll go back and forth, and it’s gonna make it very frustrating. So the bottom line is more patients may lose Medicaid eligibility during the course of care. I’m not even talking at the beginning, but during the course, you’re thinking, “Oh my God, what a hassle.”
This is why many of you say doggone it, that’s why I don’t take insurance.” In fact, I’ll let you in on a secret. In my dad’s practice when him and I were together, we took very little. In fact, my dad saw it as a charity. In fact, sometimes my dad would say, “It would be better to treat these pa- patients for free than all the administrative work,” which I’m not so sure he was wrong.
Bear in mind, though, some Medicaid plans for chiropractic and acupuncture can pay quite well, and in fact are the lifeblood of many practices. So we wanna make sure that you’re ready for that. More patients may lose their eligibility, so therefore eligibility verification has become important, done regularly.
I’ve had some people argue it should be done every visit, but I would say probably at least monthly or sooner because there may be changes that all of a sudden they’re saying it’s eligible now.” Two weeks later it no longer is. The risk of claim denials due to coverage termination is gonna be my big issue.
We wanna make sure that when someone comes in, as you’re well aware with the No Surprise Act and giving a good faith estimate, patients should be aware of what their charges are. So I think it’s gonna change how we as offices begin to make sure these patients understand if their insurance is not in effect, that’s not our fault We’ve done the best job we can to make sure that their coverage is there.
However, we’re warning them, “Your coverage may not be intact,” and as such, they would be personally liable. Therefore, they’re signing some type of financial agreement or otherwise to make sure that we’re not left holding the bag, because the truth is, I would rather not treat you and not get paid than treat you and not get paid.
So we’re gonna do a little bit more verifications, making sure it’s in line and patients understand their responsibility. So you’ve really got to conduct eligibility reviews more frequently. Now, they’re saying here generally every six months rather than annually. I would say maybe even quarterly for some, and some people may lose it retroactively.
So what may have been good through, say, March, all of a sudden for the next quarter is not. So retroactive Medicaid coverage will be reduced to one month, meaning that sometimes it could be as quick as one month it’ll be a turnaround. They used to have it where there’d be a three-month grace period. Now it’s only gonna be one month.
As a result, implement routine eligibility verifications. I’m gonna suggest if you’ve not already taken advantage of the electronic way through Availity or other systems, you really should. They’re minimal to no cost. In fact, Availity for the most part is free. But through other plans, there’s ways of getting that information.
Getting on the phone and calling, ineffective. You’ve really got to do it as an online part. If you’re a network member with me, reach out. We can go through what things you need to do. Bottom line is this: it’s not just Medicaid, though. It’s gonna be the marketplace or the exchange plans, and they impose stricter benefits on that.
I’ve just recently saw a lot of people have lost their benefits, so make sure, is it active? All we need to know when someone comes in, our job is to give you really good care. Insurance is their contract, and while we’re gonna do our best to make sure it’s covered, I want every patient understanding Our office has done the best job to verify your insurance.
However, we cannot guarantee coverage. You ever notice that when you contact an insurance, they always say this, “This is not a guarantee of coverage”? We’re gonna have to start doing the same thing. We’re not beholden to your insurance. If your insurance doesn’t cover, you have to understand your personal liability, and if they’re not ready to take personal liability, that’s fine, then we won’t accept them as patients.
Again, I go back to I’d rather not treat you and not get paid. So I wanna make sure there’s a good way of looking at this, saying, “Okay when is this policy effective? When’s the change date?” Because we have to make sure we’re gonna have potential issues where patients may experience more frequent coverage lapses.
They may lose coverage in the transition and have to be self-pay. Insurance card changes, plan changes. Here’s what the bottom line is. We’re gonna have to be more adept at verifications. It’s not as hard as you think. They’ve put so much stuff online to verify whether the person is eligible. Just plug in their ID number and you’ll see when is the effective date.
If we are proactive with that, I think we’ll run into far less problems. So really, what do you wanna start to do now? Now, just be aware. If you’re not doing much of this, I’m not really that concerned. You may say I may have a few people.” But bottom line is verify their eligibility regularly. Now, some will say before every visit.
I’m not sure I’m ready to go that far, but being if you’ve got an efficient system, that may work. Update financial policies. Make sure your patients understand their financial requirements in your office. Make sure you have a good, clear financial agreement. There’s nothing worse than someone coming saying, “Oh, everything is covered,” and when it’s not covered, they don’t wanna pay.
Remember, you’re not an attorney office. This is not one of these contingency things. If your insurance doesn’t pay, there’s no charge. Oh, no, that’s not how this works. Patients have to be understanding of their responsibility. Also, make sure you’re insu- obtaining their current insurance cards more frequently.
I would check quarterly, not just waiting for first of the year. Have you had any updates? Now, if someone’s coming in regularly, if there’s any updates, they probably make you aware. But if someone’s not been in a while, always say, “Hey, can we see your latest card?” Because a lot of times people get a new card, and they forget to tell you like, “Oh, I thought it was all the same.”
And strengthen your good faith estimate It’s very important patients understand their costs, just like we do. Don’t be afraid to be the office that we’re here to give you good care, but there’s an expectation of payment. And of course, if it’s not covered, could we put them into a self-pay plan, a prepaid plan, or even deal with a hardship?
Absolutely. But just be aware that this may change some coverages. Again, if you’re doing very little of it, may not affect you much. But realize we’re always here to help because you need to establish payment plans and coverage loss situations. What are we gonna do? If you don’t already work with me, as some of you are network members, work with me.
We’ll help you set that up. We already have some in- set up for you. Train your staff also, recognizing if they’re Medicaid eligible or they have marketplace, that has there been any recent changes? Has something changed with their job or whatever the case may be. Also, monitor your state Medicaid fees, because Medicaid fees in some states, really poor, but in other states, pretty good.
So this is something you’re gonna balance the type of practice you have, thinking of volume. It becomes more difficult if you are a type of practice that you spend a lot of time with patients, particularly in an acupuncture setting, there may not be as much value for you. So it’s something to consider whether or not is this a value to your practice or is it not.
The overall impact, it projects that it’s gonna indicate significant numbers of individuals that are currently covered under Medicaid or marketplace may lose coverage, so we wanna make them aware. But here’s the thing. As a chiropractic practice or an acupuncture practice, we are the most nimble at keeping things affordable.
Do you think most people can pay cash going into a medical practice? Absolutely not. What about coming to you? I think we do a good job as professionals at making things affordable, so don’t be afraid to put them into self-pay, prepaid, things where you can discount. My goodness, if you’re in California, you can offer a very large cash discount.
Know what your state allows. In Florida, you can do a prepaid monthly plan. So understand what your different states allow. Again, I would say reach out to me so we can make sure to set yourself up to make this be a benefit to your office, not something that’s a downer. Providers, the primary concern is not changes to coding and billing, but rather insurance patient coverage.
And if it’s not covered, put them into cash. Not a big deal. Eligibility verifications, financial responsibilities, make sure patients are clear. Just like when you go to purchase something, it’s the same thing. That part is the professional part. Make sure patients understand what they need. As always, we’re here to help.
If any of you have any concerns, reach out to me through H.J. Ross or American Acupuncture Council. If you’re a network member, we’re there to really help. We can do a one-on-one Zoom. Realize there’s some changes happening for documentation, very specifically for acupuncture. We’re having seminars this month, July 16th and the 23rd.
I hope to see you. But if not, keep a look for me online. We’re always here to help everyone. Best wishes.