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Balance billing call for action

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  • southerndoc
    replied
    Why would you base your reimbursement on Medicare rates when they are set based arbitrarily without reason and pay below normal market share?

    Leave a comment:


  • jacoavlu
    replied
    wait, are most folks payer contracts not expressed routinely as a percentage of medicare? Ours certainly are and that is the norm in my specialty and region. Frankly I don’t know how else we would do it. We bill literally hundreds of different codes and negotiating each would seem almost impossible and create a lot of opportunity for failed negotiations. As it stands negotiations are basically, hey we used to pay you this percent, now we want to pay you this (lower) percent, and then we counter with some percent, and we usually come to an agreement. But it’s all expressed as percent of medicare rate.

    I would not work for medicare rates or anything close to it across the board

    Leave a comment:


  • southerndoc
    replied
    This legislation will be challenged in court if passed at it is currently written.

    I've been writing, emailing, and calling my Senators like crazy.  They're probably tired of hearing from me.

    Leave a comment:


  • G
    replied


    many younger physicians will have always been on rvu or salary and have no idea what balance billing is.  no idea what they bill in fact.  no idea what percentage of collections they have.  etc etc
    Click to expand...


    bingo.  and since the med studs and residents don't get an education on this--and seemingly little exposure to private practice--the cycle continues.

    combine this with what I am calling an "employee mindset" not only do they not know, they don't care.

    and as a result, we get forum threads such as signing an amended contract agreement for a doc that is taking Q friggin 2 call....

    Leave a comment:


  • q-school
    replied







    wonder how many people here know what balance billing is.

    i wonder how many have income that will be directly affected by balance billing.

    thanks for sharing

     

     
    Click to expand…


    True, some specialties are affected more than others. However it is important to help each other. You help me today, I help you tomorrow….because there is always a threat coming, no matter the specialty or the employment model.
    Click to expand...


    sure.  in that sense, everyone should help with this issue because ultimately collections will drive future income no matter what anyone says.  my question was more about how many are on compensation models have uncoupled income from collections (rvu or salary) in fields that would have historically been affected.  i currently am uncoupled but theoretically otherwise would be at risk, as i was for most of my career.

    many younger physicians will have always been on rvu or salary and have no idea what balance billing is.  no idea what they bill in fact.  no idea what percentage of collections they have.  etc etc

     

     

    Leave a comment:


  • G
    replied




    to support the New York model for balance billing
    Click to expand...


    R locations would be better served to call this "baseball style arbitration" ... anything with the words "New York model" is flatly rejected in my congressional district.?

    There are several different bills or pre-bills floating around right now.  It will be interesting to see what the consolidated form looks like.  Hopefully this will fix the shenanigans of both rogue docs as well as greedy insurers.  The self-funded plans in my state got a gift this year from the legislature while the ERISA plans seem to be taking a wait and see approach, but will likely benefit if the market is disrupted in favor of the insurers.  Time will tell.  My exit plan is in place.

    Leave a comment:


  • Dreamgiver
    replied




    wonder how many people here know what balance billing is.

    i wonder how many have income that will be directly affected by balance billing.

    thanks for sharing

     

     
    Click to expand...


    True, some specialties are affected more than others. However it is important to help each other. You help me today, I help you tomorrow....because there is always a threat coming, no matter the specialty or the employment model.

    Leave a comment:


  • q-school
    replied
    wonder how many people here know what balance billing is.

    i wonder how many have income that will be directly affected by balance billing.

    thanks for sharing

     

     

    Leave a comment:


  • jhwkr542
    replied
    Hopefully this doesn't get passed. Our professional society has already been on top of this, but we're pretty small compared to primary care specialties.

    Leave a comment:


  • Dreamgiver
    started a topic Balance billing call for action

    Balance billing call for action

    As you might heave heard, Balance billing or “surprise billing” is quickly being resolved at the federal level. The outcome of the resolution will affect all of us deeply. Multiple committees and representatives/senators have proposed solutions to patients being left with massive out of network bills after emergencies.

    Insurance companies have used this urgency to craft legislation that will tie reimbursement for out of network care to either Medicare rates or “median” regional rates. This will effect ALL physician/np/pa reimbursement! In California a bill was passed linking these rates to Medicare as a benchmark. This has led to insurance companies dropping physicians from networks and ceasing all negotiations on rates to accept Medicare rates as the default. Eventually this would lead to all reimbursement at Medicare rates or a percentage add on to the Medicare rate.

    Please write an email to your state senator and your representative to encourage them to support the New York model for balance billing (Patient held harmless, independent board to assess regional payments, 80th percentile payment for out-of-network emergency care, baseball style arbitration for disagreements). Here is how you can find them:

    https://www.senate.gov/senators/index.htm

    https://www.house.gov/representatives/find-your-representative

    I have included at the bottom a sample letter and contact information for each of the Senators and Representatives to make it easy.

     

     

    Dear Sen. or Rep.        ,

     

    I am writing to urge you to oppose the surprise medical bill provisions of the “Lower Health Care Costs Act” that was recently introduced by Senators Alexander (R-TN) and Murray (D-WA). The Alexander-Murray provisions are completely unworkable for physicians and threaten health care delivery all over our country. Please revise these provisions to address the concerns of the physician community.

     

    As a physician practicing in          , protecting my patients from surprise medical bills is a high priority. In fact, well over 90 percent of our claims are in-network. To address those out of network services, I support holding patients harmless from additional out of pocket costs.

     

    To address billing disputes, I support a fair and independent dispute resolution mechanism — one that balances the interests of providers and insurance companies. As currently written, the Alexander-Murray proposal fundamentally reweights the health care marketplace to the benefit of insurance companies. Physician practices all over the country will suffer. Additionally, insurance companies will have no incentive to create adequate networks of providers. Therefore, the number of patients receiving heath care out of network will only increase. An example of this is seen in California where an out of network bill was linked to Medicare rates and has led to multiple insurance companies dropping physicians from their networks at alarming rates.

    Additionally, under this proposal, the federal government would set in law an unprecedented “benchmark” or payment cap in the commercial insurance marketplace. Payments to out of network physicians and other providers would be capped at the “local median contracted commercial amount” – an amount determined by and ultimately controlled by insurance companies. This misguided price setting will undermine my practice. It will also harm my colleagues’ practices in rural areas.

     

    The Senate should instead consider and advance a well-tested, successful model such as that provided by the state of New York, elements of which are included in Senator Cassidy’s and the Bipartisan Work Group’s proposal. New York provides robust patient protections that removes patients from billing disputes, so they are responsible for nothing more than their in-network copays and deductibles. It also creates an independent dispute resolution process to address billing disputes between physicians and insurers, and guides payment to a market-based, reasonable cost. The New York model has been in place since 2015 and studies indicate that it has reduced complaints related to surprise medical bills.

     

    Once again, I urge you to oppose the surprise medical bills provisions in the “Lower Heath Care Costs Act” and to instead support a re-balancing of the proposal.

     

    Sincerely,

    Dr.

    123 main st any town USA

     
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