Billing

The Centers for Medicare & Medicaid Services has published its latest Medicare Quarterly Provider Compliance Newsletter, which provides guidance to address medical billing process errors.

The newsletter is designed to identify common billing errors and other erroneous activities when dealing with the Medicare Fee-For-Service (FFS) Program.

Topics discussed in the January 2017 issue include the following:

  • Retinal photocoagulation
  • Facet joint injection
  • Radiation therapy
  • Stem cell transplants
  • Long-term acute care stays

The newsletter is intended to provide guidance to help health care professionals address and avoid the top issues of the particular quarter.

To access the January 2017 issue, click here.

Rhode Island has become the latest state to take steps in an effort to address the ongoing challenge of surprise bills for medical services.

As the Providence Journal reports, state lawmakers are sponsoring legislation that would provide for a dispute resolution process for emergency services and surprise bills for medical services performed by nonparticipating (i.e., out-of-network) healthcare providers, regardless of whether the services are provided within or outside of the state.

The bill — H-5012 — is modeled after similar medical billing laws passed in Connecticut, New York and Florida. California is another state that has recently seen its lawmakers take action in this area, although some physicians have pushed back against it.

The Rhode Island bill's cosponsors include House Judiciary Chairman Cale P. Keable (D-Burrillville), Rep. Carol Hagan McEntee (South Kingstown), and Rep. Lauren H. Carson (D-Newport).

Craven, quoted in the Providence Journal report, stated, "My hope is that this legislation can ease the financial burden on Rhode Islanders when medical emergencies and surprises take place without sacrificing needed and potentially life-saving care."

What is Surprise Medical Billing?

A surprise medical bill — or balance billing — happens when a patient receives a bill from a doctor, hospital or other healthcare provider who is not part of the patient's health plan's network. Often, consumers do not know they are receiving care from out-of-network providers.

For example, a patient goes to an in-network hospital for emergency care and is treated by an out-of-network doctor. The doctor and the hospital each bill $1,000 for their services, and the health plan pays them each $400. The in-network hospital can only bill the patient for copays, deductibles, and coinsurance amounts. The doctor, however, may bill for the $600 that the health plan did not pay, as well as any copays, deductibles, and coinsurance.

As Brookings reports, "Over a dozen states have enacted important protections and federal and state officials have proposed additional remedies, but these efforts are incomplete, and they pursue a variety of different strategies."

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