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A Small Step Forward on Surprise Medical Care “Balance-Billing”

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By @nicholas_bagley

The ME-P Back Story about a Decade Ago:

Link: https://medicalexecutivepost.com/2008/09/17/balance-billing-conundrum/

More on out of network Balance Billing a year ago and … today?

Per a rule released last year, CMS will now require qualified health plans to count the cost sharing paid by the enrollee for an essential health benefit. But, what about today?

***

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***

 A small step forward on surprise billing

Assessment

We’ve written about this problem before on the ME-P; and we now appreciate this guest ME-P update.

More: Balance-Billing Conundrum

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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6 Responses

  1. AMA: Top 5 Medical Billing Denials

    1. Missing information
    2. Duplicate claim or service
    3. Service already adjudicated
    4. Not covered by the payer
    5. Limit for filing expired

    Source: Advance Web

    Like

  2. Dear Dr. David,

    The Affordable Care Act made sure that no individual could be denied health coverage due to a pre-existing condition. Last fall, the Trump administration issued guidance that weakened this provision of the ACA. Fortunately, this afternoon the U.S. House of Representatives will consider legislation that would revoke the administration’s efforts to undermine these important protections.

    Contact your representative TODAY and urge them to vote yes on H.R. 986, the Protecting Americans with Pre-Existing Conditions Act of 2019! This is a critical step towards ensuring that all Americans have access to comprehensive, affordable health care.

    Sincerely,
    Gaby Witte
    Senior Manager of Government Relations
    APHA

    Like

  3. Balance Billing

    What It Is and Why Trump Wants to Get Rid of It?
    https://news.yahoo.com/balance-billing-why-trump-wants-183852980.html

    Dr. David E. Marcinko

    Like

  4. 42.8% of ED Admissions in 2016 Incurred Out-of-Network Charges

    JAMA Internal Medicine recently published research on out-of-network charges for hospital inpatient and emergency department (ED) admissions. Here are some key findings:

    • From 2010-2016, out-of-network billing increased from 32.3% to 42.8% of ED visits.
    • The mean potential liability to ED patients increased from $220 to $628 from 2010-2016.
    • For inpatient admissions, the incidence of out-of-network billing increased from 26.3% to 42.0%.
    • The mean potential liability to patients increased from $804 to $2040 for inpatient admissions.

    Source: JAMA Internal Medicine, August 12, 2019

    Like

  5. Update on BB
    [AKA surprise billing]

    https://www.modernhealthcare.com/patients/surprise-medical-bills-becoming-more-frequent-and-costly

    Dr. David E. Marcinko MBA

    Like

  6. MORE on BB

    https://khn.org/news/investors-deep-pocket-push-to-defend-surprise-medical-bills/

    Dr. David E. Marcinko MBA

    Like

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