BALANCE BILLING: The Emerging “No Surprise” Act

Balance Medical Billing

By Dr. David E. Marcinko MBA CMP®

CMP logo

The No Surprises Act is looking to make the practice of out of network balance billing a thing of the past.

CITE: https://www.r2library.com/Resource/Title/0826102549

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No Surprises Act: New Law to Protect Against Surprise ...

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Beginning in 2022, there will be few situations in which a patient can receive a bill for out-of-network care they believed would be covered by their insurance company. This new rule should especially benefit patients in emergency situations who don’t have the time or luxury to dig up the details on every provider they encounter.

CONGRESS: https://www.congress.gov/bill/116th-congress/house-bill/3630/

The No Surprises Act also requires insurance companies to provide patients with at least 90 days of coverage if an in-network provider moves out of network. That way, patients aren’t forced to switch providers immediately if such a move happens while they’re in the middle of a treatment plan.

DOCTORS: https://www.elixirehr.com/what-the-no-surprises-act-means-for-healthcare-providers/

Now, the No Surprises Act does have its limitations. Patients can still get a bill for out-of-network care if they visit an urgent care clinic for non-emergency purposes. Also, if consumers are informed that the care they’re about to receive is out of network and they give written consent to move forward, then they may get billed for that care even once the new rule takes effect.

CMS: https://www.cms.gov/nosurprises

YOUR COMMENTS ARE APPRECIATED.

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Thank You

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VIRTUAL MEDICAL OFFICE APPOINTMENT “BALANCE BILLING”

Only a Matter of Time for Some Greedy Physicians?

Courtesy: http://www.CertifiedMedicalPlanner.org

By Dr. David E. Marcinko MBA

Balance Billing [Surprise] is a medical invoice from an out-of-network provider for the difference between the total cost of services being charged and the amount the insurance pays.

LINK: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

And, we warned about it more than a decade ago.

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

Now, it has become a huge with doctors who are not subject to the rates or terms of providers in-network.

LINK: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

But, we may be slowing making progress against this nefarious practice.

ESSAY: https://medicalexecutivepost.com/2017/01/07/a-small-step-forward-on-surprise-medical-care-balance-billing/

Unfortunately, the Corona Pandemic may have simultaneously exposed a new wrinkle in the conundrum.

LINK: https://www.springerpub.com/dictionary-of-health-economics-and-finance-9780826102546.html

QUERY: Have we now arrived in the digital pandemic age with “virtual” balance billing?

LINK: https://www.firstcoastnews.com/article/news/local/watch-that-medical-bill-patient-says-virtual-appointment-cost-him-more-than-twice-the-usual-amount/77-4e2bed29-68a8-4f3e-91fa-be243f2b18bc

ASSESSMENT: Your thoughts and comments are appreciated.

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BUSINESS, FINANCE AND INSURANCE TEXTS FOR DOCTORS

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

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More on SURPRISE Medical Billing

On “Balance Billing”

By Ryan Woody Ryan

Shareholder at Matthiesen, Wickert & Lehrer, S.C.

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ASSESSMENT: Your thoughts are appreciated.

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