Get Ahead of the OBBBA Changes Before 2027 

Before we get started, I'm going to launch an audience poll just to see who is in attendance today.

And then after the poll, we'll turn it over to Sarah, Jessica, and Ray.

A lot of billing specialists, practice managers, physician practices, outpatient facilities.

An acupuncturist.

Okay. Let's turn it over to Sarah, Jessica, and Ray. Thank you all.

Hello, everyone. Good afternoon or morning, depending on where you are in the country. I myself am in the Hudson Valley, of upstate New York. I saw a couple of Upstate New York folks chat in there, so I'm excited to be among neighbors.

And, Jessica, hails from Kansas City. So we're really excited to be with you here today. Thank you all for being here and taking on and trying to tackle this topic, which is ever changing. We're first gonna kick off with a little bit about ourselves.

Who are we, OfficeAlly, and a quick background there. We're gonna then spend some time just talking about the one big beautiful bill act itself. You know, some folks reference that as OBBA or OBA. Others call it HR one.

We're gonna talk about what has changed recently, and, of course, changes are imminent and still coming, and we're still learning a lot, and a lot of interpretation is happening. So what does that mean for your revenue cycle? When do things take effect? And just a high level overview of the things that we know now.

After that, Jessica will walk you through how you can actually prepare for this, and give you some, tips and hints and some solutioning on your workflows. Our goal is, we mentioned before, is we'll close with some q and a if time allows. So start thinking about some of those questions you may have, and I see you're probably gonna drop some into the chat as well.

So moving on to the next slide, we're gonna start talking about quickly, who is OfficeAlly and what, where OfficeAlly is comes from. Officeally was founded in two thousand with one focus, connecting payers, to providers so that claims can move faster and practices can get paid. We're headquartered in Nashville with offices across the country. We have offices in Vancouver, Washington, in Salt Lake City, in, San Antonio. And, we are currently supporting more than eighty thousand active customers from independent practices all the way to really large health systems. We process over one billion transactions annually, supporting more than one point four million NPIs, and more than seventy percent of our claim volume goes direct to the payers.

That direct connectivity matters for speed and accuracy, and it's the tools that Jessica will cover later, at a little bit more of a scale in our discussion.

So moving on to talking about the one big beautiful bill act or OBBA. You know, we wanna talk a little bit about actually what it does and what it means for your revenue cycle. Some context as I go through and, add highlights, the things that have happened recently. I'll add some federal context, and I'll talk a little bit about, you know, where states are making some interpretations along the way.

Hr one or the one big bill bill act was signed into law on July fourth twenty twenty five. It requires that all forty four ACA Medicaid expansion states implement these work requirements and other requirements, by January first in twenty twenty seven. And it moves Medicaid renewal forms from annual to every six months.

The impact that that's gonna make on your patient population is great. And a lot just to kind of keep the state thoughts in mind, some states are already ahead of schedule. A theme that I will talk through as I go through these slides is, you know, some states are moving a little faster. Some states, don't really have their plans documented or presented out yet. So really start doing your best in your environment and the states and the patients that you, support and where they live to try to make those interpretations of these rules.

So, before we go through each of these eight provisions, we're going to talk through what they are here. We're going to flag, you know, that just days ago on June first, CMS issued the interim final rule or what's mentioned as the IFR.

That defines, how these work requirements are going to work in practice.

We've been waiting for this rule, and the good news is that, it's a little more firm and there's less interpretation and guessing that has to happen. But unfortunately, there's still some pretty strict rules when it comes to the things that you're going to have to, abide by. It will this IFR locks in the medically frail standards, the verification that methods that can be used for, income look backs, and all of the other state obligations.

Every informal guidance or educated guest before June first is now a federal rule.

The document is about four hundred pages itself. It landed harder than anyone was expecting, but at least that picture is more clear.

It's a little more stringent, but there's still a little bit of room for interpretation as you as you go.

Ifr becomes effective July thirty first twenty twenty six, and the comment period will close that same date. Now oftentimes those things can shift, but it's just important to know that those are the dates that, the government has put out there. As we go through each of the provisions, I'm going to layer in those IFR details. But the short version is, again, CMS set a strict standard for most states, and what those folks have been planning for, which means more patients are at risk of losing coverage than the original provision suggested.

CMS is predicting two point three million disenrollments in twenty twenty seven.

And with the work requirement in the six month renewal impact, other organizations are predicting that up to four point nine to ten point two million nationally.

And the administration's figures and independent estimates are pretty far apart, so it's important to keep an eye on those numbers as as they start to determine how states are gonna implement these things, what the medically frail definition is, and, you know, just keep an eye on how those states are are working through.

So we're gonna lean into the first provision here and move on to the next slide. This is the first one, which is our Medicaid eligibility determinations.

As you see, states must determine eligibility every six months instead of annually starting in twenty twenty seven. And of course, there's impact, implications there.

Let me just move my slides here. The large piece of legislation for billing professionals and practice administration administrators for all of these provisions carry risk to reimbursement, and different types of coverage disrupt disruption are going to really affect how you manage and have those conversations with the patients. So one of the things that we're early on suggesting is early and frequent communication with that patient population who may not even know that this is about to happen.

So Sorry. Just one thing I wanted to add about that is I know what a lot of our clients and members are doing to, to determine what that financial impact would be is kinda going back before the Medicaid expansion and before some of this access was and seeing what your population looks like then to determine what kind of financial impact's going to apply to your organization, and then how are you gonna be ready for it? What type of alternate funding is going to have to be set aside, like charity care, things like that to be ready for the impact for those that are losing coverage? Go ahead.

Yeah. Those lessons learned from the unwind are really important.

So, you know, hopefully, some of the the those teams team members and those folks that are part of that are good, but always, you know, reach out to your colleagues too.

Yeah.

So let's start with those return redeterminations. Currently states redetermine Medicaid eligibility annually, and it's gonna be that every six months. That six month cycle isn't just an administrative formality. It's a real eligibility gap that can cause real claim denials.

And, again, we saw this during that COVID era unwinding because that there was continuous enrollment. And then as that started to unwind, we started to see some changes happen.

There's some just notes that I'll make.

Some states are already live with this. Nebraska went live on May first under the the new the new rules. Montana is implementing July first, so that's coming up right around the corner. And Kentucky has enacted a three months look back.

So there's a little bit of that's happening. And, again, I will say this a couple of times, really kinda lean in and do a little investigation on what's happening state by state for the for the populations that you support.

Our key takeaway here is checking that eligibility enrollment just once, is probably not a safe workflow. Making sure that you're checking eligibility enrollment within the entire life cycle of that account and and the revenue cycle and that patient journey is is helpful. Layer in data, layer in those extra checks. Checking visit by visit is no longer a best practice.

The next provision is our shortened retroactive windows. I think we have to go back one more slide. I apologize.

There we go. This provision works directly alongside that redetermination change, and together they close a safety net that made practices really relied on for a long time. So before the OBBA, Medicaid qualified, coverage was qualified, expenses incurred up to ninety days prior to the application date. This will cut it down to thirty days. So your retroactive window is much shorter.

So not only are we losing patients, we're they're getting less time to apply, within new application cycles. So that means there's more work for your team. So staffing up those folks that are your navigators, your financial counselors, the folks that help with that enrollment is really gonna be important because you're gonna need need to chase down that information from those patients to have good, complete applications.

So missing that thirty day window, the revenue is kind of gone. So we want to make sure that we get more applications readied, full, complete, so that there's less issues of denial later.

The next provision is our community engagement work requirements.

What's changed here is new work, education, and voluntary requirements within that. So a lot of folks are calling this just the work requirements.

They're also labeled in documentation as a community engagement requirements.

The OBBA introduces community engagement requirements for certain Medicaid enrollees. Able-bodied adults ages nineteen to sixty four in expansion states must meet those eighty hours per month of work via work, education, being in school, working through a job search or community service to maintain that coverage.

There's a lot of gray area within this, and a lot of states are interpreting that differently. This morning, I was on a webinar with how New York is going to start to assume that and collect in that data.

One of the things to note is self attestation, is not something to lean on. Lean on systems and tools.

Within the exemption, there are federal exemptions to this. Pregnant women, individuals who are age blind or disabled or medically frail, parents caretakers of children under the age of thirteen or a disabled dependent, foster care youth, under twenty six, veterans with disabilities, dual Medicare Medicaid enrollees, Native American tribal members, and SNAP TANF recipients already complying with those rules are exempt. And of course, just get familiar with that. I think having leaders and folks on your teams who are these subject matter experts will help.

The IFR didn't narrow the medically frail exemption in a way that will surprise most practices. A condition must be significantly significantly impair the individual's ability to do that eighty hours per month. So I think there's a lot of guidance and a lot of assumptions that are being made with what that means.

CMS did explicitly list asthma, hypertension, type one, two diabetes, and some others, qualifying things as not see things as being not qualifying. So we really need to kind of lean into that and learn that as time goes here.

And then states have been building their own exemption code list based on the original CMS signals, but the IFR did change that. So, if you had any previous guidance that you were looking into, it's time to start looking at what came out in that lovely four hundred page document a couple of weeks ago.

There are other notes within this, but again, lean into what the state is doing. Really make some good assumptions for you and your team, and the patients that you support.

The IFR within this did add one good piece of good news. An income based alternative path, was introduced. Individuals earning five hundred and eighty dollars or more per month. That's eighty hours at the federal minimum wage of seven twenty five automatically meet that requirement.

But within that, you have to look at your state minimum wage and a couple other qualifiers. They're still working on gig workers, those folks that have, you know, kind of side jobs or things that are not consistent salary positions. So take a look at that. Ten ninety nines will be needed for that.

There'll be a lot to know, and all of this is just saying this is more risk. This is more burden. This is more stuff that you guys have to keep track of.

Moving on to mandatory cost sharing. The OBBA introduced the mandatory cost sharing, the co pays, deductibles, and other out of pocket expenses for certain Medicaid enrollees.

The revenue impact isn't just about collecting those amounts. It's about what happens when patients decide the new costs aren't manageable and choose to disenroll. That disenrollment is a risk for you, because once they disenroll, the work requirement has to be restarted. The whole process has to be restarted.

A patient who loses Medicaid for noncompliance loses Medicaid and can't access subsidized marketplace coverage either. And then they're gonna arrive at your practice as a self pay with no fallback insurance pathway. So that's where some of your other programs, planning your bad debt, and all of that is important, but just knowing and having retention of these patients versus having to recover off of them is the strategy that we're suggesting.

The next provision is the restricted eligibility for noncitizens. The OBBA restricts Medicaid and ACA marketplace eligibility for certain immigration status says that previously qualify for coverage. So patients who have been on your panel for years may lose that coverage without an advanced notice to your practice. So even if you have a patient that's been active and has always been on Medicaid, they just may not because they're in that cycle, of being enrolled, or taking those actions, it's really important to just have that communication with them.

Maybe some touch points when they come in to register for their appointment if they are your Medicaid patients To kind of highlight that and say, hey, these changes are coming. We just wanted you to know that. Just give them some guidance. We know that, some large hospital systems are working with local agencies like libraries and outpatient plate folks and outreach centers and shelters for folks who may, have Medicaid enrollment in certain population areas, and they're collaborating on that communication campaign effort.

The lesson for this, provision is, that it broadly it applies broadly, and don't assume what's gonna happen. Definitely verify that patient's history of having active coverage at prior visits does not mean that their coverage is gonna be valid today or in future visits.

The next provision is the end of the ACA marketplace auto renewals. What's changed here is that it has been eliminated. Patients must reenroll each year.

So starting in twenty twenty eight plan year, patients must actively reenroll or they'll lose their marketplace coverage.

This is going to create significant, increases in your coverage lapses. Patients who simply miss the enrollment window will come present as a self pay. And again, that's a window and a gap that you want to try to fill.

Active coverage may still remain for some of those patients, but finding that coverage before writing up the visit is where the opportunity is. So that's our tip and trick on that one.

Next is the pre next provision is the pre enrollment verification for subsidies.

The HR one adds a pre enrollment income verification step for ACA subsidy applicants. Previously, app applicants could receive subsidized coverage provisionally while verification was being completed. Under these new roles, that presumptive pre enrollment step is, not gonna happen. Verification must happen before coverage is approved. So the practical effort here is that more patients are presenting without that confirmed coverage and some are gonna be general genuinely uninsured. Others may be enrolled in coverage through a spouse or employer or another pathway, but it hasn't been identified. So making sure you do all those checks, having tool sets that allow you to do that are gonna be really important.

The next and final provision I'm gonna talk about today before passing it off to Jessica to talk about how you can prepare is the real time price transparency tools.

With this, the one big beautiful bill strengthens the price transparency requirements. Meaning, patients will fortunately have increasingly access and ability to expect what those up front costs will be before services are rendered. That really allows the patient to plan and put more power in their hands. You cannot produce an accurate cost estimate without knowing the patient's current coverage, their plan, their deductible status, and their cost of sharing obligations.

And with that eligibility verification is the foundation of any price transparency workflow. So making sure that you have tool sets to be able to do that will be helpful.

And without that, all the cost estimates are gases.

Those are the eight provisions and policy. I could go on hours about probably each of them with everything that's coming out here, within news. But, within each of those provisions, the revenue risk is real. And I'm gonna pass it off to Jessica to walk you through, how you can act on this before twenty twenty seven arrives.

Perfect. Thanks, Sarah.

Can we just go one more slide here?

Perfect. So let's talk about how you can prepare. And before I start with this, I wanna let you guys know that I was an end user. I spent over a decade in RCM before moving into product management. I understand your work queues, the sitting on hold with payers, piecing together coverage from multiple portals.

So when I talk about this, I wanna talk about this from sitting in that seat versus a product road map to give you guys some tips, tools, and tricks to kind of where we're headed and what's coming in the future.

So let's start with insurance verification, eligibility, benefits from OfficeAlly. The reality is heading into the one big beautiful bill act, patients who were covered last month may not be covered today. And with shorter retroactive billing windows, you have less time to cut less time to catch those gaps after the fact.

That makes proactive eligibility verification, checking coverage before the services are rendered, the single most important workflow you can change in your practice today.

Eligibility and benefits is directly in service center and practice meet. Your front desk or billing staff verifies coverage at or before the appointment. No payer portals and no phone calls. So why does this matter specifically under OBAF? For three reasons. The redeterminations are moving to every six months.

New work requirements create unpredictable mid coverage terminations. And as Sarah just mentioned, the non citizen eligibility restrictions will affect patients who have had continuous coverage for years.

None of these are going to trigger a notification for you and your practice. The only way to know if a patient is covered for today's visit is to check on or before the visit. Industry research continuously shows that eligibility and registration errors are one of the leading drivers of preventable denials and this is even before the one big beautiful bill act takes place. This isn't complicated. It's just needs to be consistent and just a reminder to check coverage on every encounter.

Now let's take verification a little bit further with insurance discovery f c. So we all know that insurance verification works well when you know who the payer is. But with the one big beautiful bill, it is about to grow a population you don't have answers for. For patients who show up with no coverage or who think they're uninsured when really they have a policy somewhere.

So let's play out this scenario. A claim comes back with a PR twenty seven denial. Expenses occurred after coverage terminated. Under the one big beautiful bill, you're going to see a lot more of these.

Instead of chasing the patient down to ask if they picked up replacement coverage, we can go ahead and run Insurance Discovery FC.

It searches for active coverage using basic demographics. Just name, date of birth without your team having to know what payer to check. When coverage gets found, what would have been written off becomes a billable claim. For OfficeAlly customers, Insurance Discovery FC is an add on right inside Service Center and PracticeMate. You don't need a separate login. There's no integration. And think of this as more of a tool instead of, writing off a claim, it searches for coverage for you.

So see what's broken before it costs you. Now let's talk about more on the claims side because the one big beautiful bill is gonna create pressure there too. We already know that billing teams are spending thirty to forty percent of their day hunting for problem claims across fragmented reports, spreadsheets, etcetera. On average, it takes four point seven days just to identify what claims can be repairable.

A delay that was manageable before it becomes a real write off risk when retroactive billing windows shrink. That's exactly what service center is built to solve. Your home page shows you what matters most, what needs fixing, what's been paid, and what's at risk. You identify the problem, correct it, and resubmit without ever leaving OfficeAlly.

No more bouncing around between payer portals. You see what's broken while there's still time to do something about it.

Is your clearinghouse ready for the one big beautiful bill act? Whether you're already with OfficeAlly or you're evaluating your options, here's the framework that I want you to think about. Four things your clearinghouse should already be doing. First, accept claims in any format.

This could be direct data entry, batch upload, ANZX twelve, and even paper. If yours forces you to one method, claims fall through the cracks, and those cracks becomes revenue that you do not collect on. Second, fix errors in the same place you submitted them. Identify, fix, and resubmit without ever leaving the system.

That speed is gonna become critical as a one big beautiful bill billing windows shrink in twenty twenty seven.

And third, for payers that support it, go ahead and use claim status. The status should come to you. One place, no phone calls, no portal hopping. You shouldn't be the one chasing the data. Make the system do it.

And fourth, ERA should come to you automatically tied back to your claims. Chasing remits across separate payer portals waste time, and it creates reconsolidation errors that compound really fast at volume.

These are aspirational features. They're a baseline. And if your clearinghouse isn't meeting these baselines today, the one big beautiful bill makes this gap a lot more expensive starting in twenty twenty seven.

And Ray, I think I'm handing it over to you now.

Yep. Absolutely. Perfect. Great. Thank you both, Sarah and Jessica. We've got, quite a few questions that have come in. I'm gonna go ahead and start with the the most common one we're getting.

A lot of the participants are wondering who this actually, is going to affect.

They're asking, is this all payers? And, you know, based on the provisions that you guys have gone over, these are directed toward Medicaid and the ACA marketplace.

So just to clarify that for most of you guys that are asking that question.

Sarah, this this one goes back to you. You had made mention of understanding what's going on in your state and how far along they are, and they're releasing more information state by state. Is there a good way for them to be able to check how it's going with their particular state. One question that came in was specific to Wyoming.

And I don't know if you guys have a tool or a place to go to other than just working with their Medicaid divisions there?

We're finding that most states, hospital associations or other medical, you know, physician group associations are doing a lot of those presentations and having webinars, at that state or, you know, level. That's how they're distributing it through the association side. I I think it's desperate still in some places. There's no answers in some states.

But other states, what we're doing is we're just starting to gather that information and building out tools to communicate to our end users and our clients. We certainly have, there's some states that if they're non expansion or not, you know, do not have to abide by all this. And then state by state, there are some rules. I was doing that check on that Wyoming question here. Yeah. And I let me see if I can pull that back up because I had a little bit of a note.

But from what I understand, CMS will publish the state implementation plans and waiver approvals on medicaid dot gov.

Their states must submit their timelines on their plans for all of this under the IFR and that final rule. So that should be your authoritative go live source, but I would really start to do other due diligence and seek out from the state on Medicaid websites, from those associations you trust, build out some work groups with some partner organizations that you think. And I think there's other ways to get information. We don't have a hub quite yet, but if you have specific questions, I've done lots of research in the last, six months, so you certainly can reach out.

Also, this is for the Medicaid expansion states. So states like Texas are not affected by this. That was another question that came in. I think it's Texas and Florida, if I'm correct.

List. I think Texas, Florida. I have a list here.

I'll pull it up for us.

Okay.

And I'll put it in the chats.

And then also, yeah, to clarify, someone just asked a clarifying question. This does not affect commercial insurances that are non ACA, and that is correct?

Correct. The Affordable Care Act is what ACA is. And then just like any regulation like this, I know some of the questions are, where can I find more of this information documented? That interim final rule that was released is going to have all of this information. Now granted, that's a big document. So we thank you so much, Sarah, for giving us the highlights over that, and we know that it's brand new information, and a lot of people are still digging into it.

Yeah. I mean, even the states themselves are coming back with questions.

Again, was on that New York one today. There was a Virginia one next week. So I think that there's we're gonna discover a lot over the coming weeks, and we might be primed for another webinar here soon.

Okay. Now everyone's asking about their state. What about North Carolina? What about Kansas? Okay. You're getting those. Right?

That's great. I will I'll take some notes, and we'll do due diligence. But, again, just your first step is to head over to that CMS website and take a look and see if there's some summaries. And there's gonna be guidance. I know that Kaiser Foundation and other places like that are gonna start to document more of this out for you.

Another question that came in, will they retro eligibility? And that was the thirty days that you were discussing. Correct?

Yeah. I think you'll still be able to do your retro eligibility for thirty days, no longer ninety.

Yep.

And then they're asking about terminations.

Will this be will it be thirty calendar days? So could a patient lose Medicaid eligibility mid month?

I don't think that there's much guidance or documentation that I don't think anyone will lose it mid mid month from what I from what I've read and understand.

The the drop offs and the folks that will lose it will because be at the term of their current coverage. But in some place in some states, I believe they're going to, have a full restart. So, again, look to your state's guidance on that.

Yeah. And then some of the questions too we're asking, are they going to be checking eligibility every thirty days? And I think one of the points that you guys made was checking eligibility for every single visit because it can move so quickly. If you want the most accurate information, you should be checking eligibility, not just with Medicaid, but every insurer because coverage changes.

Yeah. I would highly suggest that if you're not doing it more than once, or you're not touching each, account, spend that time and invest in the tool to do so. Do it at scheduling.

Do it at registration. Make sure nothing has changed, especially if you're scheduling things early out way early. And then, you know, as you're going through the process, folks may that drop off of Medicaid may start to enroll into something else. Maybe a job has changed. So there's just smaller, tighter windows for all of us to do our work now.

Yeah. And then, you know, one of the other questions that we're getting in here is, are these proposed rules, or is this a final rule? And this is a final rule.

So unless there's other regulations released, this is going into effect.

Yep.

Sure is.

A question that we're getting, do elderly patients who have Medicaid as secondary also have to reapply every six months?

Anyone that is in the age blind or disabled population is not subject to these changes. They'll still be in their twelve month renewal recycle process.

Great.

And I got a little bit I just I just checked my notes here a little bit, on the mid month, disenrollment. Under the IFR, states must run eligibility checks at least once a month. So disenrollment can technically hit mid cycle once a member falls out of compliance with work requirements or the income threshold. So once those requirements start and all those, know, those standard income rules, If states are not, disenrolling, properly, they they could get pinged. There's no statutory requirement that terminations align with month end, meaning a claim submitted at the mid month may be valid at date of service but denied by the time it gets adjudicated. So just knowing that, you know, really be mindful of your time windows. And if someone was eligible last month, they may not be eligible next month when you run that claim.

Yeah. And for those of you that are on the provider side that are on this call, you know, really checking eligibility is gonna be your best option, but also educating your patients. In a lot of instances, they're gonna be paying more attention to information that you provide than sometimes their insurance companies provide. So I think understanding how to educate your patients on why this information is important, They should be proactive in getting this information to, maintain their eligibility is gonna be really important for providers so that your patients can maintain coverage.

This is a question.

They're asking if, if states have different language, would that supersede what the federal regulations are requiring?

I don't think so. I think the federal regulations are the federal regulations. The states may have guidance and tool sets that vary. They may, you know, go check work requirements for from, you know, a volunteer database, or they may be able to do things a little bit differently operationally, but I think they all have to follow that guidance.

Okay. Another eligibility question. Can they lose coverage further back than thirty days? I know that this has been an ongoing issue for Medicaid where at the time of the visit, you verified eligibility. It's showing that they were eligible, and then you bill the service. And months later, you get a recruitment because they found out, well, their system wasn't updated, they really weren't covered.

Was there anything in the provision that accounts for that?

I don't think I think the the provision is it's going to be that ninety day to thirty day window. Jessica, do you have any with the claim make with claim side of that, any insight outside of just that thirty day retroactive backdate?

No. They haven't really given much on that one. So I'd just say the sooner you can get it back get it in, the best, but, they haven't really given any insight on that yet.

Okay. Great.

And then the computing the community engagement requirements, someone's asking for information on that, that will be found in the interim final rule.

And that's one of those is up to interpretation. Right? So how are you going to prove that you're applying for a job? How are you going to self attest that, you know, you're working volunteer hours?

So I think state by state, that's where the states wanna make sure they have strong tool sets for those states that wanna keep those folks enrolled because they wanna make sure that they have satisfied that work requirement at that time. And I do think that, you know, there's a lot that we're gonna learn on interpretation, and some standards that are probably gonna come out of it. I do think the IFR gave us a lot more clarity than we were expecting on June first for that, and some good, you know, categories to look into. But I think, you know, I think there's gonna be more to come with that topic.

So something that just came into the chat, this is not my understanding that the marketplace is going away after this is available. That is not tied to this provision at all. No.

So don't panic, those on the call. No. Now going back to the frailty regulation or requirements, this is where documentation becomes so important on the clinical side of things, documenting not only that the patient has the chronic condition, but the impact that that chronic condition has.

Some of the examples that they gave for conditions was like asthma or diabetes, hypertension. Not every patient with that condition has the same impairments or limitations, And I think that that's what they're trying to get at, with the information that they're now requiring, not just that the patient has a condition, but how is that condition impacting them to understand if they still qualify.

So this is a good practice for you guys that are in CDI audit, provider education, making sure that they understand that they're capturing that. I mean, this is something they should be doing anyway, not just for this rule, but for all rules, really identifying and capturing and documentation how sick your patient is and what limitations they might have.

So that's a very important part of this.

Yeah. And I think, you know, for folks that are blind and disabled, they're gonna be able to define and qualify that by the fact that they're a recipient of socials you know, SSDI.

Folks that have conditions that are serious or medically complex, like HIV and AIDS or sickle cell disease, those are types that you can be sure that that will qualify for medical frailty. But I think there's a bunch that are just kind of in that gray area. So kind of understanding, that that's still not fully, defined out yet, and I think it's up to everyone's interpretation.

Yeah. Another question that came out, not sure if you know the answer to this one, but what kind of impact is this going to have on it being easier to get cost estimates from payers?

Are there payers on the call?

I I don't have I don't have a quick answer on that one.

I think that I'm hoping that everyone will start doing what they need to do in their system so that that that can happen. And the it's important to get those cost MS. The states are gonna have to work with payers, and the states are gonna have to work that to get that information out there. So, that's a good question. I'd like to follow-up with more on that one.

Okay. And then as far as the, price transparency requirements that you discussed, Sarah, is that specific to Medicaid only right now?

I think it's just globally price transparency, but Okay.

That's a good question too. Okay.

And I know that there were some questions about your solutions. Let me go down to that.

They're asking how up to date accurate will eligibility checks be through OfficeAlly?

It's real time. It happens right then and there. As soon as you click search, it automatically goes out to the payers, searches them, and comes back in real time.

And, does it work for all payers is another is a different question we got.

Yep. We're connected to a ton of payers out there and, yes, all payers.

Another question that came in specific to your solution. Do you have a back office to be able to pull eligibility for patients?

I don't know what that is really.

Are you asking if we have one that would pull it for you?

I think so. I think that's what they're asking. I think that's what they're asking.

Unfortunately, I wish. That would be huge for us, but at the moment, we do not.

Okay. Another question is on the insurance discovery tool, can you automate the eligibility review, or is it a manual patient by patient review?

It's a great question. We have manual, but we also have batch functionality. So you could send us in an entire batch, and we run that in real time and give it back to you as well.

Okay. And we also have other solutions where if you have, say, an interface, real time interface coming into one of our some of our other solutions that it can check that, as self page, patients are registered.

So, it can we have a variety of ways within that environment as well.

Great.

Okay.

Okay. Another question about your solution. This particular, participant, they do their billing through their EHR. Is there a way to just use this checking tool without using other aspects of OfficeAlly? So can you just get this solution that you showed?

For insurance discovery, I believe, is what you're what they're asking?

Yes. I think so.

I will have to check on that. I know right now, I believe you have to use either PracticeMate or Service Center, but I can come back to that question if they're interested. Okay.

Another clarification. This these provisions do not affect nonexpansion Medicaid states. Is that correct? Correct. That is correct.

Yep.

So that is correct. Not all fifty states.

It dropped it into the the switch states at one point in the chat here. Let me go back and pull that back up again.

So the states that have not adopted full Medicaid expansion are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. Some states have partial expansion or unique programs that provide coverage to those, income adults, but, they're not considered full expansion states.

Okay.

So many good questions.

Okay. This one yeah. It's a good thing we clarified that because that one is still coming through over and over again.

Okay. This is if the if they're not contracted with Medicare with Medicaid, if it's a provider that's not participating in Medicaid, do they need to worry about any of this? Well, if they're accepting ACA marketplace, then, yes, it would apply to you. Yeah.

So it's not just Medicaid.

I'm gonna do some clarifying notes here for us on that.

And I did see a question that came through, I think, So but I just wanna address because I think it's a great question. And the question was, has timely filing guidelines been changed? So the OBBA itself does not directly modify timely filing deadlines.

Those are still in governed by individual payer contract and state prompt pay laws. But because of that short and retroactive window, you know, anything that's Medicaid aligned does tighten that practical window for billing that backdated coverage. So that's just, I wanted to make sure we have that. And then states to watch for that that are in high risk for timely flying are, Pennsylvania, Ohio, and Virginia where those uninsured populations have large coverage gaps, and those contracts, may have their again, may have their own timely fine filing windows.

And our best practice on that is run that eligibility at every visit. As we said before, that will help, mitigate some of those issues.

A question we got was how is this going to affect benefits for certain medical conditions?

And this is more about who qualifies, not necessarily what care they qualify for. So coverage of, certain procedures or certain supplies that the patients are getting, I I'm not sure that that's gonna be addressed here. That's gonna be more of a state by state determination of what patients qualify for once they are eligible for the medical coverage.

Okay.

Just looking through here to see if there's anything that is missed.

So a follow-up question they that I got based on my documentation statement is, you know, who should be responsible for documenting any patient's limitations?

And I would say any medical provider that's interacting with that patient. If you're treating a condition and you're seeing what the patient's, the severity of that condition and limitations it's putting on them, I think everyone providing care can contribute to the record in order to to really capture the severity and complexity of what's being, treated for that patient.

Oh, another follow-up question for you guys on the tool. Are you able to check all fifty states of Medicaid coverage?

Yes. Okay.

We are coming up on time. So thank you so much, Sarah, Jessica, and Ray for the great presentation. Thanks everyone for joining us today. Reminder to find past and upcoming webinars, visit the resource center at aapc dot com slash resources.

And if you're interested in learning how eligibility and benefits, insurance Discovery FC, and service center can help your practice prepare for the One Big Beautiful Bill Act's impact, let us know in the post event survey that will pop up on your screen after the webinar concludes to answer some of your questions. We'll be sending a copy of the slides and recording to your email early next week. Thanks again. We are looking forward to our next webinar event coming soon, so keep an eye on your inbox for that invitation.