The CMS issued its rule on the 90-day grace period last August and released additional guidance (PDF) in October.
But, in a letter to CMS Administrator Marilyn Tavenner (PDF) earlier this month, the American Medical Association and 85 other physician groups urged the CMS to develop new requirements on when and how providers receive notification about the payment status of a patient's policy.
“By allowing issuers to 'pend' claims during months two and three of the grace period, rather than being responsible for claims incurred during the entire three-month grace period as CMS had originally proposed, CMS has unfairly shifted the burden and risk of potential loss for patient nonpayment of premiums to physicians,” the letter stated. “This financial burden will be untenable for many physicians. “
The CMS requires insurance companies to notify providers about the possibility of denied claims when the patient is in the second or third month of the grace period. But, according to the letter, “the timing and manner of such notice is left to the discretion of the insurers.”
“We believe these current notice requirements are inadequate and will lead to administrative confusion for physicians and practices,” the letter added.
Physician groups also are calling for the CMS to make insurers fully responsible for any claims if they provided inaccurate information about a patient's status during the final two-thirds of their grace period.
The rule “imposes significant risk” on providers to be left holding the bag for uncompensated care, attorney Michael Smith wrote in a post on the Health Law Firm Blog back in November. Smith added that the rule could be subject to manipulation by individuals who become “serial abusers” of the grace period by intentionally withholding full payment for their premiums.
The office of the trade association America's Health Insurance Plans was closed Monday due to inclement weather in Washington, so a representative was not available for comment.