Looks like ending balance billing is part of the latest COVID relief package.

[Dr Mantis Toboggan]

Fitting way to end 2020 for our specialty.

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Members don't see this ad.

 

[Torsion]

Congress to ban surprise bills, include provider grant fix in year-end deal

Lawmakers on Monday released details of major COVID-19 relief and government funding legislation, including many provisions important to the healthcare industry.

www.modernhealthcare.com

Based on what I'm reading here, it sounds like a fairly favorable outcome compared to what could have been.

 

[sylvanthus]

I haven't looked into specifics, but I can only guess its the typical "settle for less than a worst case scenario." Id love to see EM stop being on the defensive and setting for what scraps were dealt and actually go on the offensive for once. Were constantly threatened with something awful, and roll over and take it because they give us something less awful. Seriously not a good long term strategy.

 

[southerndoc]

It's better than what's been proposed before, but still not the best. I haven't read the entire text (because it hasn't been released yet), but I believe this will only apply to ERISA insurance plans and not those that get their insurance through the marketplace.

 

[Boatswain2PA]

but I believe this will only apply to ERISA insurance plans

Incrementalism has to start somewhere....

 

[turkeyjerky]

Meh. Balance billing is a pretty indefensible practice. It seems mainly employed by CMGs and other unscrupulous groups.

 

[doctalaughs]

Meh. Balance billing is a pretty indefensible practice. It seems mainly employed by CMGs and other unscrupulous groups.

It is indefensible on face value, however it’s the only thing that allows many groups to negotiate with near-monopoly insurance companies (that you’ll stay out of network).

Really docs need to unionize and bargain as whole specialties against insurance. It doesn’t make sense that big groups get better contracts anyway.

 

[deleted941485]

It is indefensible on face value, however it’s the only thing that allows many groups to negotiate with near-monopoly insurance companies (that you’ll stay out of network).

Really docs need to unionize and bargain as whole specialties against insurance. It doesn’t make sense that big groups get better contracts anyway.

I’m sure insurance companies were happy about that. You can never leave a bad contract ever.

 

[Mushdoc]

I think now the cat is out of the bag, but this practice was likely part of the reason private equity moved so aggressively in on ED contracts. Unfortunately they are not going to now suddenly leave, but likely new for new ways to squeeze profits out

 

[Xerxes1729]

It's not a perfect solution but it's better than some others that have been proposed. The practice was going to have to stop sooner or later. How would you justify it to a non-medical person? "In order to allow doctors more leverage to negotiate with insurance companies, it's very important that they be allowed to stick patients with financially ruinous bills, even if the patients think they are doing everything right by going to a facility their insurance says is in-network."

 

[scoopdaboop]

It's not a perfect solution but it's better than some others that have been proposed. The practice was going to have to stop sooner or later. How would you justify it to a non-medical person? "In order to allow doctors more leverage to negotiate with insurance companies, it's very important that they be allowed to stick patients with financially ruinous bills, even if the patients think they are doing everything right by going to a facility their insurance says is in-network."

I mean a lot of the "public outcry" often happens when a patient gets stuck with some massive bill anyways. You get rid of that/ limit that, trust improves for doctors.

 

[Torsion]

The bulletin sent out by Mark Rosenburg this morning indicates a good deal of success on the legislative front. As mentioned in the article I posted above the balanced billing legislation allows for IDR without a threshold. Also the bulletin mentions that the proposed 6% Medicare reimbursement cuts were negotiated down to 2% - keep in mind that other hospital based specialties initially faced 10% cuts with these fee schedule changes. While we didn't get everything that we wanted I'd say that this is a testament that advocacy at the state and national level works and the physician lobby still has some clout.

 

[Raryn]

Also the bulletin mentions that the proposed 6% Medicare reimbursement cuts were negotiated down to 2%

Yeah. They had congress zero out the new complexity code that was supposed to be added. So the majority of the benefit to outpatient clinic specialists just evaporated. My back of the envelope math is that the average endocrinologist whose medicare billings were supposed to increase by 16% is now going to get 5% benefit or less. Probably less.

Congratulations.

 

[bronx43]

Yeah. They had congress zero out the new complexity code that was supposed to be added. So the majority of the benefit to outpatient clinic specialists just evaporated. My back of the envelope math is that the average endocrinologist whose medicare billings were supposed to increase by 16% is now going to get 5% benefit or less. Probably less.

Congratulations

So is 99214 still 1.9 wRVU?

 

[Raryn]

So is 99214 still 1.9 wRVU?

Based on the email I got from the endo society, I think so. But the complexity code - G2211 - is not being implemented.

 

[bronx43]

Based on the email I got from the endo society, I think so. But the complexity code - G2211 - is not being implemented.

I see. I mean just the increase from 1.5 to 1.9 wRVU (26% increase) for a level 4 return is quite a boon for outpatient docs overall. While it’s not an overwhelming victory for medicine specialists, it’s better than anything we’ve been given for decades.

 

[RustedFox]

I see. I mean just the increase from 1.5 to 1.9 wRVU (26% increase) for a level 4 return is quite a boon for outpatient docs overall. While it’s not an overwhelming victory for medicine specialists, it’s better than anything we’ve been given for decades.

O RLY?

 

[bronx43]

O RLY?

No.

 

[Backpack234]

The bulletin sent out by Mark Rosenburg this morning

Bulletin?

 

[Torsion]

Bulletin?

It was an email titled "Congress Votes on E/M Cuts, Surprise Billing, Etc. - ACEP Advocacy Pays Off for You" sent around 8am this morning. Obviously needed to subscribe to ACEP emails.

​

 

[Raryn]

https://www.ama-assn.org/system/files/2020-12/2020-combined-impact-table.pdf

We'll see how it actually plays out, but this isn't as bad as the initial reports had it.

 

[southerndoc]

Midlevels are getting an 8% increase. They bill at 80% of the physician fee when they see by themselves. Getting closer to physician reimbursement for being seen by a midlevel.

 

[Raryn]

Midlevels are getting an 8% increase. They bill at 80% of the physician fee when they see by themselves. Getting closer to physician reimbursement for being seen by a midlevel.

As I understand it, midlevels aren't getting any explicit increase - just the underlying codes are. Most midlevels work outpatient, so they're getting benefits from that. That is - FM is supposed to go up 11% or whatever, so most NPs are also going up that amount (the overall average is less because they don't *all* work in primary care).

 

[PikminOC]

Midlevels are getting an 8% increase. They bill at 80% of the physician fee when they see by themselves. Getting closer to physician reimbursement for being seen by a midlevel.

Citation please