Concierge Practice: How To Keep It Legal Post Affordable Care Act

Event Information
Product Format
Prerecorded Event
60 Minutes
Product Description

Know The Current Limitations On A Concierge Practice

As exchange plans continue limiting provider networks and ramp down compensation, it’s not surprising that more professionals are exploring or pursuing different options. Some physicians are conducting a concierge or retainer practice that offers upgrades to cash-paying patients. Some have decided to “opt out” completely out of insurance programs. Others continue to participate in governmental and managed care arrangements, but are considering whether going “out of network” makes more sense financially and operationally, than remaining network providers. Still other professionals may adopt multiple approaches.

The Affordable Care Act has imposed new requirements that impact the ability to accept and charge patients for concierge service, if they also participate in exchange plans or in Medicare and traditional commercial plans. The ACA defines services that are “covered” in exchange and other plans. The law also requires every citizen to obtain insurance, meaning that many “cash” patients will in the future be covered.

Providers who seek to “opt out” have to follow a set of procedures to extricate themselves from Medicare or managed care plans. They will need to enter into agreements with Medicare patients regarding future care. Further, payer requirements and state laws also impose limits on doctors or groups establishing a cash or concierge practice.

In this 60 minute session, expert speaker Wayne J. Miller, Esq. will discuss the current limitations on a concierge practice and how it may still be viable in the new environment.

Topics covered in the session:

  • What requirements do exchanges impose on providers?
  • Definition of services that are “covered” in exchange and other plans as per ACA
  • Private vs. public exchanges: what providers need to know
  • Must you serve exchange patients under existing contracts?
  • Insurance plan provisions that can trìp up retainer practices
  • Terms to look for in new deals to serve exchange patients
  • How and when to opt out of Medìcare fee for service provider status?
  • Reducing lìability risk for nonpayment
  • Due diligence steps recommended before taking on exchange business
  • Health plan licensing and other state law hurdles

Who should attend? Clinics, Practice Managers, Physicians, Medical Groups And Health Care Consultants, Health Care Facilities

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About Our Speaker

Wayne J. Miller - Healthcare Compliance Expert

Wayne J. Miller, Esq., is a founding partner of the Compliance Law Group, Los Angeles, a law firm focused on health care industry legal compliance for clients nationwide. Wayne has practiced healthcare business and regulatory law throughout his 30-year career. His firm represents a wide range of healthcare industry clients throughout the nation. He is a frequent speaker for The Coding Institute national teleconferences on healthcare reimbursement, transactional and regulatory...   More Info
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