House Bill 935 Alan S. Gassman, Esq. [email protected] Pariksith Singh, M.D....

House Bill 935House Bill 935

Alan S. Gassman, [email protected]

Pariksith Singh, [email protected]

Lester J. Perling, [email protected]

Recordings of this webinar and additional materials can be found at:http://www.gassmanresourcecenter.com/previously.recorded.webinars.html

Copyright © 2011

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SummarySummary

Gassman, Perling, and Singh

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SummarySummary House Bill 935 was codified as Ch. 2011-122,

Laws of Florida.

Approved by the Governor on June 2, 2011.

Effective: July 1, 2011.


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SummarySummary The major changes in this bill are:

The bill provides physicians an incentive to post prices in their respective practices.

The bill requires clinics and urgent care centers to post their 50 most frequently used charges.

The bill requires a health care clinic licensed under Florida Health Care Clinic Act (FHCCA) to ensure compliance with the publishing and posting requirements.


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Making Lemonade Out of Lemons: Making Lemonade Out of Lemons: The Bill’s Unanswered QuestionsThe Bill’s Unanswered Questions

What exactly is the difference between an Urgent Care Center and any clinic that accepts walk-ins?

Can a Primary Care Provider simultaneously be an Urgent Care Center?

Are there any exceptions for Primary Care Providers?

The definition of Urgent Care Facility and other meanings and definitions within the bill are extremely vague.


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Prior to HB 935Prior to HB 935 The Patient’s Bill of Rights and

Responsibilities was established in 1991 and codified in § 381.026, Florida Statutes.

The statute established:

The right for patients to expect medical providers to observe standards of care in providing medical treatment and communicating with their patients.


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Prior to HB 935Prior to HB 935 Upon request, the patients had a right to be

provided with a reasonable estimate of the cost of medical treatment prior to treatment.

However, the reasonable estimate did not preclude the health care provider or health care facility from exceeding the estimate or making additional charges.

There is no statutory requirement that a physician post a schedule of his or her fees for medical services.


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HB 935 ChangesHB 935 Changes Primary Care Providers Primary Care Providers

HB 935 defines a Primary Care Provider (PCP) as a health care provider who provides medical services to patients which are commonly provided without a referral from another health care provider. (Example: pediatricians, family practice physicians, and internists)

A PCP may publish and post the schedule of medical services that he or she provides and the cost for each service.

Note: Physicians are not required to post, but are permitted to do so.


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Primary Care ProvidersPrimary Care Providers If the PCP chooses to post the pricing schedule:

The schedule must list, at least, the 50 most frequently performed services provided by the PCP;

The bill requires the posted charges to consist of those fees that would be charged to an uninsured patient paying for medical services by cash, check, credit card, or debit card;

The schedule must be posted in a conspicuous location near the reception area of the provider’s office in an area of at least 15 square feet; and,

The bill requires that an estimate of charges for medical treatment provided to a patient be consistent with the posted schedule of charges, if the PCP posts a schedule of charges pursuant to the bill.


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Primary Care ProvidersPrimary Care Providers The bill provides PCP an incentive to post prices by

giving the following: Exemption from one period of license renewal

fees.

Exemption from the continuing medical education requirements for a single 2-year period.


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Primary Care ProvidersPrimary Care Providers If a PCP chooses to publish and post a

schedule of charges, the schedule must remain posted as long as the PCP maintains an active license in Florida and provides medical services to patients.

If the schedule does not remain posted, the PCP must pay the exemptions license fee amount and make up any continuing medical education credits that were waived.


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Urgent Care CentersUrgent Care Centers The bill amends § 395.107, Florida Statutes, and

defines term “urgent care center” to include a facility or clinic that provides immediate, but not emergent, ambulatory medical services to patients with or without an appointment.

In other words, clinics that offer “immediate” appointments may be considered an urgent care center under this definition. The definition does not include the emergency

department of a hospital. Making an appointment on short notice for an existing

problem related to a current course of treatment would most likely not fall under “urgent care center.”


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Urgent Care CentersUrgent Care Centers Specific requirements for urgent care centers are:

They must publish a schedule of charges for the medical services offered to patients;

They must include the prices charged to an uninsured person paying for such services by cash, check, credit card, or debit card;

The schedule must be posted in a conspicuous place in the reception area of the urgent care center;

It must include the 50 services most frequently provided by the urgent care center;

It may group services by three price levels, listing services in each price level; and

The posting must be at least 15 square feet in size.


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Urgent Care CentersUrgent Care Centers The bill imposes a fine of not more than

$1,000, per day, upon an urgent care center for each day that the schedule of charges is not published and posted as required by the bill.


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Health Care ClinicsHealth Care Clinics HB 935 amends § 400.9935, Florida Statutes,

to require a medical director or clinic director of a health care clinic licensed under FHCCA, to ensure compliance with the publishing and posting requirements.

If an applicant for health care clinic licensure meets the definition of “urgent care center" it must post and publish many of its charges so patients can see them.


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Health Care ClinicsHealth Care Clinics Specific requirements for posting are:

Post in a conspicuous place in the reception area of the facility.

Must include prices charged to uninsured patients paying at the time of service.

The sign must be at least 15 square feet in size and provide prices for at least the top 50 most frequently provided services. The clinic is not limited to listing just 50 services.

The pricing can have up to 3 price levels.


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Recommendations/Recommendations/Potential IssuesPotential Issues

If a physician-owned clinic applies for a certificate of exemption from AHCA in the future, it may have to comply with the new posting requirements, even if it does not meet the law’s definition of “urgent care center.”

Florida law does not require clinics that are exempt from clinic licensure obtain a certificate of exemption, but many health care plans, Medicare and Medicaid, may require one for credentialing.


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While the new law may make health care pricing more transparent across the board, it also might dissuade patients from initially seeking medical care.


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Along with the recent bill to limit the prescribing and dispensing of controlled substances in an uncontrolled manner, physicians are now forced to be more compliant and forthright with patients and the government.

It is recommend that all primary care clinics that offer any kind of walk-in or immediate appointment service follow the requirements of the law and establish a list of the 50 most common procedures offered at that location along with the cost involved for any self-pay patient.


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Such bills always create work for a practice at the outset, but by raising the bar, practices become more compliant and consumer friendly.

Some procedures may not be easy to price. In that case, one may wish to list the price range of the procedure and note the limitation of such price range.


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Further ResourcesFurther Resources

The text of the Bill is available at: http://www.flsenate.gov/Session/Bill/2011/0935/BillText/er/PDF

An Article, a sample Schedule of Charges as shown on Slide 22, and the chart found on Slide 2 is available from Gassman Law Associates, P.A.


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Questions?Questions?

Lester Perling, [email protected](954) 745-5261

Dr. Pariksith [email protected](352) 688-2883

Alan S. Gassman, [email protected](727) 442-1200


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Sample Schedule of ChargesSample Schedule of Charges


2011 SELF-PAY PRICING CODE OFFICE VISITS AND PHYSICALS PRICE 99201 NEW PATIENT LEVEL 1 OFFICE VISIT $ 44.00 99202 NEW PATIENT LEVEL 2 OFFICE VISIT $ 76.00 99203 NEW PATIENT LEVEL 3 OFFICE VISIT $111.00 99204 NEW PATIENT LEVEL 4 OFFICE VISIT $170.00 99205 NEW PATIENT LEVEL 5 OFFICE VISIT $211.00 99211 RETURNING PATIENT LEVEL 1 OFFICE VISIT $ 21.00 99212 RETURNING PATIENT LEVEL 2 OFFICE VISIT $ 44.00 99213 RETURNING PATIENT LEVEL 3 OFFICE VISIT $ 73.00 99214 RETURNING PATIENT LEVEL 4 OFFICE VISIT $109.00 99215 RETURNING PATIENT LEVEL 5 OFFICE VISIT $146.00 99391 PREVENTATIVE CARE/PHYSICAL < 1 YEAR OF AGE NEW $ 90.00 $ 76.00 99392 PREVENTATIVE CARE/PHYSICAL 1 TO 4 YEARS OF AGE NEW $ 96.00 $ 84.00 99393 PREVENTATIVE CARE/PHYSICAL 5 TO 11 YEARS OF AGE NEW $ 98.00 $ 85.00 99394 PREVENTATIVE CARE/PHYSICAL 12 TO 17 YEARS OF AGE NEW $105.00 $ 93.00 99395 PREVENTATIVE CARE/PHYSICAL 18 TO 39 YEARS OF AGE NEW $105.00 $ 93.00 99396 PREVENTATIVE CARE/PHYSICAL 40 TO 64 YEARS OF AGE NEW $125.00 $101.00 99397 PREVENTATIVE CARE/PHYSICAL 65 OR > YEARS OF AGE NEW $135.00 $115.00 99WRK WORK PHYSICAL $ 40.00 99SCH SCHOOL PHYSICAL $ 25.00 99DOT DEPARTMENT OF TRANSPORTATION PHYSICAL $ 50.00 CODE OTHER PROCEDURES PRICE CODE INJECTIONS W/O OV PRICE

20550 TRIGGER POINT INJECTION $ 61.00 95115 SINGLE ALLERGY SHOT $ 11.00 20610 JOINT ASPIRATE/INJECT $ 84.00 95117 MULT ALLERGY SHOTS $ 13.00 69210 EAR LAVAGE (PROVIDER) $ 84.00 J3420 B-12 SHOT $ 24.00

80100 DRUG SCREEN $ 21.00 + LAB

J1100 DECADRON SHOT $ 25.00 90658 FLU SHOT $ 25.00

81002 URINALYSIS $ 4.00 90636 HEP A&B PREVENTATIVE SHOT $100.00 81025 URINE PREGNANCY TEST $ 9.00 90746 HEP B SHOT $ 60.00 82270 OCCULT BLOOD $ 23.00 90649 HPV/GUARDASIL SHOT $150.00X3 82962 BLOOD SUGAR BY BGM $ 10.00 90732 PNEUMONIA SHOT $ 50.00 85610 PT/INR $ 6.00 90736 SHINGLES/ZOSTAVAX SHOT $185.00 86580 PPD/TB TEST $ 9.00 90703 TETANUS SHOT $ 28.00 87880 STREP TEST $ 25.00 93000 EKG $ 22.00 INJECTIONS & IVS WITH OV 97388 BP MONITOR $ 13.00 J1885 TORADOL 15 MG SHOT $ 4.00

SUTURE REMOVAL (OTHER MD) $ 44.00 J1956 LEVAQUIN IV $ 22.50

G0101 PELVIC EXAM $ 39.00 J2920 SOLUMEDROL <40 MG $ 5.00 Q0091 PAP TEST $ 46.00 J2930 SOLUMEDROL <40 MG TO 125MG $ 5.50 94760 PULSE OXIMETRY $ 6.00 J2950 PHERGAN 50 MG $ 4.00

94640 NEBULIZER TREATMENT $17.00 + MED

J3301 KENALOG/CORTISONE 10 MG $ 3.00 96360 IV FOR 1 HR (EA HYDRATION) $ 61.00

94799 PEAK FLOW TESTING N/C 96361 IV TO 8 HRS (EA HYDRATION) $ 17.00 36415 BLOOD DRAW $ 10.00 96365 IV 1 HOUR (DIAGNOSIS/DRUG) $ 75.00 96372 THERAPEUTIC INJECTION $ 25.00 96366 IV TO 8 HOURS (EA/DIAGNOSIS) $ 13.00 90471 IMMUNIZATION INJ OTHER $ 23.00 96523 PORT FLUSH $ 27.00

House Bill 935 Alan S. Gassman, Esq. [email protected] Pariksith Singh, M.D....

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Transcript of House Bill 935 Alan S. Gassman, Esq. [email protected] Pariksith Singh, M.D....