Basics of the Affordable Care Act

The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010. Though, the PPACA has faced challenge and opposition, it is a milestone in the history of healthcare in the United States health. Essentially, the PPACA has reduced the power of health insurance companies and provided doctors with greater control.

Highlights of the PPACA:

  1. Allows young adults to remain on their parent’s insurance until age 26

  2. Prohibits health insurers from implementing lifetimes caps on health coverage

  3. Prohibits the implementation of higher premiums for minors with pre-existing conditions

  4. Allows for coverage of preventative services

  5. Implementation of health insurance exchanges

  6. Provides additional funding for the Children’s Health Insurance Program

  7. Implements a requirement for those able to purchase health insurance to do so or pay a penalty


*In June 2012, the Supreme Court upheld the PPACA’s individual mandate penalty, which qualifies as a tax.


How will the ACA affect physicians?

Doctors’ practices will benefit from increased financial security:

Medicare bonus payments will be provided to doctors for primary care services, and also for practicing in shortage areas.

Small private practices can purchase health insurance in the newly, implemented health insurance exchanges.

Access to more insured patients which means increased revenue opportunities for the practice


Doctors encouraged to use of electronic medical records (EMR) and coordinated care:

Movement to standardize billing and implement guidelines for a secure, confidential, electronic exchange of health information

The formation of coordinated care teams is encouraged to provide care at lower costs, by emphasizing prevention, and reducing unnecessary hospitalizations.


Physicians can still earn incentive money for implementing a EMR system.


Your medical billing service can explain to you how this will impact your practice financially and how to prepare.



Affordable Care Act – Department of Health and Human Services
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