Call to Arms! – Support HR 3502 – Protecting People from Surprise Medical Bills
As your billing and practice management organization, RCM feels your pain at every critical turn. It has been our mission to support our clients through the changes that affect their practices, offer creative solutions, and work collectively to resolve any issues. One major change affecting multiple providers in the California anesthesiology community was the introduction of California Assembly Bill 72 (AB72). This, coupled with the ongoing debate as the issue gains momentum on a national level, is definite cause for concern.
Providers have now joined the struggle, as they are faced with today’s reality –
- Lengthy negotiation periods and closed networks
- Less than favorable contracted rates and low out-of-network reimbursement
When AB72 was first introduced, many of you heard our call. Providers who forwarded the requested payer lists for their facilities offered us the opportunity to further analyze their practices, rule out obsolete payers, make recommendations, and take action when necessary to bring you into network participation.
A few of the issues we have encountered include:
- Transition of network participation requests and pre-screening to automated processes with slow response times
- Unpublished Area Contract Rate (ACR) for out-of-network services
- Some reimbursements are based on 125% of Medicare for out-of-network services
The ASA has partnered with other facility-based colleagues in an effort to strongly oppose the “Alexander-Murray” surprise medical bill provisions because the proposed rate-setting approach is a non-starter for anesthesiology specialists.
The “Alexander-Murray” solution includes
- Requirement that an in-network facility make guarantees to patients and health plans that all individual providers there should be considered in-network
- Arbitration through an independent judge for dispute resolution of all “surprise bills” over $750
- Reimbursement of the provider or facility at the median rate for services in a certain geographic area
Frank Pallone Jr. (D-NJ) and Representative Greg Walden (R-Ore) have released draft legislation to end surprise bills. The Pallone-Walden “No Surprises Act” ties out-of-network payments to a “median in-network amount”. This structure would surely cause harm to physicians’ practices by limiting their ability to achieve fair negotiations with empowered payers.
Although the Senate HELP Committee passed their solution to surprise bills, key policy leaders in the House, including Congressman Raul Ruiz MD (D-CA) and Phil Roe MD (R-TN), supported by Anesthesiologist/Representative Andy Harris MD, have introduced an alternate proposal – HR 3502 – “Protecting People from Surprise Medical Bills”. This bill was first introduced on 6/26/2019 and is currently in the first stage of the legislative process.
This more favorable proposal
- Bans surprise medical bills
- Creates a fair mechanism for physicians and insurers to resolve billing disputes
The ASA remains optimistic as this proposal continues to gain support, and have issued the following statements:
Call your Legislator to oppose “Pallone-Walden”, and cosponsor HR 3502, the “Ruiz-Roe” bill.
The CSA also strongly supports HR 3502 and is encouraging all anesthesiology specialists to immediately contact their representatives.
HR 3502 – Contact your Representative
What else can you do?
- Ask your facilities for a list of their contracted payers, and forward it to us at firstname.lastname@example.org or fax to 714-347-1082
- Discuss your high-volume payers and contractual status with your Billing Representative, Billing Manager, or Contracts Manager