Insights From Our Editors

How Will the Affordable Care Act Affect Your Practice?

Nearly half of patients don’t feel that the Affordable Care Act (ACA) will impact the eyecare they seek and products they purchase, findings from The Vision Council’s VisionWatch May 2014 Economic Situation Study suggest. Some 47.3 percent say “the ACA has not impacted my insurance coverage or health care behaviors,” while 34.4 percent say they’re “not sure/don’t know” how they will be impacted. Another 9.8 percent report “I have changed general insurance coverage as a result of the ACA,” while 7.8 percent say “I will cut spending on upcoming eyewear and eyecare products in the future as a result of the ACA.” Some 4.1 percent say they have “changed vision care insurance coverage as a result of the ACA.”

There are two components of the ACA that you must have in place right now: the Essential Pediatric Vision Benefit and preparation for the narrowed networks.

The Essential Pediatric Vision Benefit will be completely implemented over the next three years. This year it is implemented for children from birth through age 18 (it stops on the 19th birthday) for employers with more than 100 employees, next year for employers with more than 50 employees and then the following year for everyone.

This year you need to contact each of the third parties for which you are a provider and find out how they are going to cover the exam and glasses or contact lenses that the child receives every year from the Essential Pediatric Vision Benefit. What frames are available, what lenses, what is not covered, what you will be reimbursed… these are a few of the questions for which you must have answers. Without these answers you cannot properly administer care to the covered children who come to your practice.

The narrowed networks of the ACA means that not every eye doctor will be in the narrowed networks. Here are steps you need to take now to improve your odds of being in the narrowed networks rather than on the outside looking in.

1) Implement all levels of HIPAA. Example: Do you and your staff confirm two personal identifiers for every patient every time the patient moves from one staff member to the next in the office?

2) Pass all levels of Meaningful Use.

3) Contact every ophthalmologist you are working with and let them know that you want to be in any narrowed network that they are in so that you can continue to co-manage patients together.

4) Keep up with what is happening in your state. How many Accountable Care Organizations have been formed? Where in the state are they located?

If you are not HIPAA-compliant and you have not passed all levels of Meaningful Use, then you will not even be considered for the narrowed networks. If you do not know what is happening in your state, the narrowed networks can be formed and leave you out because of lack of knowledge on your part.

Your action plan for today is to make sure you are prepared for the Essential Pediatric Vision Benefit and the narrowed networks of the ACA.

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