Federal Surprise Medical Billing Update.Dec 20, 2020 · Federal Surprise Medical Billing Update....
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1 Federal Surprise Medical Billing Update. Ed Gaines, JD, CCP Vice President Regulatory Affairs & Industry Liaison Zotec Partners, LLC [email protected] Greensboro, NC 919-641-4927 1 Faculty Disclosures: I am an officer of Zotec Partners, LLC, an ED revenue cycle & practice management company. 2 1 2
Transcript of Federal Surprise Medical Billing Update.Dec 20, 2020 · Federal Surprise Medical Billing Update....
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Federal Surprise
Medical Billing
Update.
Ed Gaines, JD, CCP
Vice President Regulatory Affairs &
Industry Liaison
Zotec Partners, LLC
Greensboro, NC
919-641-4927
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Faculty Disclosures:
I am an officer of Zotec Partners, LLC, an ED revenue
cycle & practice management company.
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mailto:[email protected]
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Presentation objectives:
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https://www.kff.org/slideshow/2019-employer-health-benefits-chart-pack/4
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https://www.kff.org/slideshow/2019-employer-health-benefits-chart-pack/
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Why should a physician group care about changes in
OON laws even if less than 5 or 3% of your group’s
health plans are OON?
➢ Congressional Budget Office (CBO) & “Pay As You Go” (PAYGO)
Rules.
➢ CBO “scored” HR 2328, the E&C bill—no IDR as originally
proposed: $20 Billion+ in “savings” which means increases in corp.
taxes due to the reductions in medical expenditures over 10 yrs., as
rates converge to the “median in network rates.”
➢ “The vast majority of health care is delivered inside a patient’s
network, and more than 80% of the estimated budgetary effects of
Title IV [SMB provisions] would arise from changes in in-network
payment rates.”
➢ “CBO and the JCT [Joint Committee on Taxation] estimate that by
creating a method for reimbursing OON care at median in network
rates, payments to providers—inside and outside of networks—
would converge around those median rates.” (emphasis added)
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“In late Q4 ’19, Physicians were out of time outs, running
the 2 minute offense & down 4 points, & then ……”
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https://www.buzzfeednews.com/article/paul
mcleod/surprise-billing-deal-richard-neal
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https://www.buzzfeednews.com/article/paulmcleod/surprise-billing-deal-richard-neal
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Bi-partisan, bi-cameral compromise announced Friday Dec. 11th w/
release of the 372 page “No Surprises Act”
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Bi-partisan, bi-cameral compromise announced Friday Dec. 11th w/
release of the 372 page “No Surprises Act”
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Bi-partisan, bi-cameral compromise announced Friday Dec. 11th
w/ release of the 372 page “No Surprises Act”
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Bi-partisan, bi-
cameral
compromise
announced
Friday Dec. 11th
w/ release of the
372 page “No
Surprises Act”
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TX--Informal settlements are at +4X of the initial
payment, IDR is > 5.3X of the initial payment.
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10 months of TX TDI data continues to show
strong results for clinicians
➢ 32,036 IDRs filed—86% by EM docs.
7% anesthesia & surgeons et al rest.
➢ Settlements: when IDR is settled,
clinicians receiving 4.43X of initial
payment.
➢ Adjudicated IDRs: clinicians receiving
4.74X of the initial payment.
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Part I--SMB summary:
➢ Federal legislation very difficult to
predict—if not by the end of 2020, issues
will fall into next Congress in 2021.
➢Physician advocacy was key to defeating the
health plans in June & Dec. ’19.
➢Possibility of a re-set w/ new POTUS &
Congress?
➢ Q&A
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Contact information:
Ed Gaines, JD, CCP
Vice President of Regulatory Affairs &
Industry Liaison.
Zotec Partners, LLC
Greensboro, NC [email protected]
919-641-4927
Follow me on Twitter: @EdGainesIII
http://twitter.com/EdGainesIII
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mailto:[email protected]://twitter.com/EdGainesIII
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