Study Looks at Anticipated ACA Reimbursement Trends in ER

(HealthDay News) – As a result of implementation of the Affordable Care Act (ACA), outpatient emergency department encounters could reimburse considerably more for both previously uninsured patients who obtain Medicaid coverage and for those who move into private insurance products, according to a study published online Oct. 31 in the Annals of Emergency Medicine.

Jessica E. Galarraga, MD, MPH, and Jesses M. Pines, MD, MBA, from Gorge Washington University in Washington, DC, conducted a secondary analysis of 2005–2010 data from the Medical Expenditure Panel Survey to examine differences in the payments, charges, and reimbursements ratios by insurance category. To reflect likely changes in insurance status after ACA implementation, comparisons were made between two groups: the uninsured who will be Medicaid eligible afterward vs. Medicaid insured, and the uninsured who will be Medicaid ineligible afterward vs. the privately insured.

The researchers found that, for outpatient emergency department encounters for the previously uninsured who gain Medicaid insurance, reimbursement may increase by 17% (40% vs. 34%). During the same period, moving Medicaid ineligible patients to private insurance may increase reimbursements by 39%  (54% vs. 38.8%).

“Although our study does provide insight into the future, multiple factors will ultimately influence reimbursements after implementation of the act,” the authors write.

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