Update on the Status of Surprise Billing Legislation, February 2020

After much inaction on Capitol Hill, while Congress was consumed with other political matters, major legislative action resumed in attempting to fix the patient surprise billing conundrum. What follows is a recap of the changes and quickly evolving nature of surprise billing legislation.

  1. Currently, three main bills are working their way through the House and Senate:
  • Ways and Means committee (H) – most favorable to billing companies.  No set arbitration limit. No set threshold for arbitration eligibility. Does not set reimbursements values
  • House Education and Labor (H) – establish payment rates for claims less than $750.  Claims above $750 there would be eligible for the arbitration system.   Cannot bundle claims together to get to the arbitration limit.
  • Energy and Commerce (H also aligned with the Senate Help committee) – kind of similar to House Education, including payment rates and threshold on arbitration.  Also, limits on how often you can bring a party to arbitration are specified, including time limits on timely filing.

2. We believe that the stars may align by the May timeframe to get a bill through the House and Senate, assuming that the House and Senate can pass a piece of legislation.

3.  Due to the complex scoring mechanism assigned by the CBO (Congressional Budget Office – that assigns the costs or savings to these bills), the best bill for the physician may not score the highest (most savings) and thus might not pass.

The lobbying effort is starting to accelerate

4. Groups are starting intense lobbying effort to make sure the bills most favorable to them – will win

5. NPR ran a piece late last week on surprise billing that implied that physicians are greedy and should accept an average payment for the good of the society, sponsored by the Kaiser Foundation.

https://www.npr.org/sections/health-  shots/2020/02/12/804943655/doctors-push-back-as-congress-takes-aim-at-surprise-medical-bills

6. EDPMA launched an email to its membership – call your congressman to try to stop the House Education and Labor bill!

As more information becomes available on the important topic of surprise billing, look to the AdvantEdge blog for regular updates.

David Nicholson, Executive Vice President

Mr. Nicholson has over 25 years of experience in the healthcare industry. At AdvantEdge he is responsible for monitoring legislative initiatives impacting specialty physicians reimbursement, billing, and coding.

 AdvantEdge Healthcare Solutions is a national top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for emergency medicine physician groups since 1967.   If you have questions about how AdvantEdge can improve your billing and coding to collect every dollar that you’re legally and ethically entitled, please call us at 877-501-1611 or email info@ahsrcmstg.wpengine.com.