美国国会解决意外账单问题，但担忧依然存在
ASPS一直是余额账单问题的主要声音, maintaining opposition to out-of-network (OON) billing legislation as a key priority in the Society's advocacy agenda. 通过在联邦和州一级积极解决这个问题, ASPS has collaborated with various stakeholders and state society partners to shape and improve surprise billing proposals and combat narrow insurance networks.
协会在116中围绕OON计费的广泛努力th Congress came to a head recently with the passage of the federal end-of-the-year package on December 21, 其中包括一项名为 没有意外的行为. 这是立法过程中经常发生的情况, the efforts of ASPS and a broad coalition of organized medical specialties produced substantial improvement to a final package that still ultimately fell short of a clear win for physicians. Fortunately, patients will be held harmless and spared shocking bills for the balance of what's owed to an out-of-network physician.
然而，ASPS仍然关注的结构 没有意外的行为 could result in the eventual accelerated narrowing of networks as private payers stop contracting with certain specialties unless providers agree to in-network payments under the median. 我国支付争议制度的法律结构是, 根据国会预算办公室的数据, 很可能将网络内支付推向中位数.
通过数字:平衡账单的一致意见
ASPS has focused intensively on out-of-network billing legislation at the state level since the issue became "nationalized" in 2016 and appeared in multiple states simultaneously with each new legislative session. 当这个问题在2018年提交到国会时, ASPS在这个问题上与主要声音合作, 包括参议员比尔·卡西迪, MD (R-LA)和Sherrod Brown (D-OH)在联邦提案的最初起草阶段. 贯穿整个116课th Congress, ASPS staff and physician leaders also participated in various coalition efforts within the physician community; convened regular meetings with health care committee staff and key balance billing influencers on Capitol Hill; and lobbied extensively against federal bills that would have had devastating effects on doctors.
In the 116th 国会、社会:
- Sent 58 letters 向国会阐明协会的结余账单立场, 表达关注并提供具体建议
- Signed on to 28日联合信 进一步加强医学院的收支平衡策略
- Activated 9个医生草根运动 encouraging ASPS members to contact their members of Congress to support ASPS's balance billing principles
- Conducted more than to reinforce the need for an equitable solution to balance billing during the Society's 2019 Advocacy Summit and 2020 Regional Fly-Ins.
最后一击
As negotiations in Congress around the end-of-the-year package reached their final stages, ASPS worked to ramp up its advocacy efforts in response to the proposed OON billing provisions.
While acknowledging that concessions were made in an effort to make the bill more palatable to physicians, ASPS noted in a December 14 letter to Congressional leadership that the legislation is still, "on balance, 很大程度上偏向于支付者而不是医生, 特别是那些小型和农村的诊所."
该协会还启动了对整个美国的基层警报.S. membership encouraging physicians to contact their representatives and request amendments to the legislation. ASPS staff worked with the New York Society of 整形外科医生 (NYSSPS) to help mobilize members on the issue, 这也是州一级的NYSSPS的立法优先事项吗.
在国会就该计划投票前一周, 美国科学院工作人员与委员会工作人员进行了四次通话, 国会议员和众议院议员. In spite of the communication throughout the process between organized medicine and congressional policymakers, it was clear in these final conversations that very little room remained to alter the legislative proposal after it was released. Of note, 最终的协议是两院制的产物, bipartisan negotiations between three committees – was released just days before Congress was slated to adjourn.
分析新的结余计费策略
ASPS's primary concerns with OON billing provisions in the omnibus spending bill largely fall in the area of independent dispute resolution (IDR), a process for determining appropriate payment for out-of-network care when there is a dispute between a physician and a payer. ASPS认为结构 没有意外的行为 会增加这些争端的可能性吗, 结果是, 印尼卢比向支付者倾斜的失衡是一个重大问题. This imbalance exists because (1) the median in-network rate is listed as a standalone factor for the arbitrator to consider when selecting between the provider or the payer payment request, and (2) any reference to physician charges or charge-based data is expressly prohibited.
State experiences show that a legislature directly and exclusively referencing a particular arbitration criterion is viewed by arbitrators as the legislature deeming that criterion the most appropriate. 在联邦OON政策的情况下, 哪个突出了网络内比率的中位数, his results in insurers' submissions to the arbitration process looking more "reasonable" because of their proximity to the congressionally-favored median in-network rate.
此外，该法律规定印尼盾各方之间有90天的冷静期. While there are structures in place to bring all disputed payments that accrue during that 90-day period to IDR in one batch on day 91, there is tremendous concern that small and rural practices could have a difficult time going 90 days without revenue, and there is no requirement that they be paid for inadvertent or emergency out-of-network care.
进步，但没有时间自满
While the OON billing provisions in the final federal relief package represent significant progress relative to the concepts that were initially introduced – which included mandatory in-network status for certain specialties, 对网外服务的补偿固定在网内费率和1美元,500 threshold to access IDR – their passage also signals that the specialty's work on balance billing continues. This action by Congress is ultimately a win for insurers that demands continued federal work and further increases the urgency of all state OON advocacy efforts.
ASPS will remain engaged in efforts to push for concessions to the IDR process to better support small and medium-sized practices, 并继续与国家社会伙伴在国家OON改革方面密切合作.