Out Of Network/Balance Billing Prohibition Fails on Assembly Floor/
 Issue Not Going Away
 

Last week on the last day of session for the current Legislative year AB 533 (Bonta) failed passage on the Assembly Floor by a vote of 38 to 10. It was three votes short of the 41 votes for passage and also shows that a large portion of the Assembly members did not vote, i.e. 32 members. The bill was back in the Assembly for what is known as Concurrence meaning the Assembly, which had passed the bill earlier in the year, was only being asked to vote to agree with the amendments made in the Senate. The CRS remained in opposition to the current version of the bill along with the CMA and other medical specialty societies. 
 
The author continues to focus on removing the insured patient from the middle of the reimbursement dispute when the patient receives services from an in network hospital or other facility and receives a "surprise" bill from a physician who also provides services and is not contracted to that plan or is out of network.

The current version of AB 533 would prohibit the out of network physician from charging or collecting from the patient any more than their co-insurance and deductible under their policy. It would prohibit balance billing and require the plan to reimburse that physician/group at the comparable Medicare rate.

AB 533 would exempt hospital emergency services that are used to stabilize the patient, which would include some radiology/imaging services. Providers remain unhappy with an interim payment rate would use an Independent Dispute Resolution Process (IDRP) that is undefined and not loser pays format. The bill lacks any provisions to incentivize or require the plan to have an adequate network or contracts with hospital based physician groups. The fact that all the plans support the bill and all the providers oppose the bill is a good indication of a lack of balanced approach.

The issue is far from over and AB 533 could be taken up when they reconvene in January. The vote demonstrates that there are members on both sides of the aisle that support finding a solution to this problem. The CRS will continue to push for a solution that does remove the patient from the dispute but also provides fair reimbursement to providers.


California Radiological Society
Annual Meeting in Newport Beach 
 

 
Please join radiologists, business managers and residents from around the state at the CRS Annual Meeting October 2-4, 2015 in Newport Beach, CA. The program this year will offer a variety of talks on issues that impact diagnostic radiology and radiation oncology including;
  • alternative payment models for Medicare/ Value based payments for radiology
  • ACA implementation in CA
  • Future of the radiology report in the EHR era
  • Updates on Medicare/Medi-Cal and state legislation
  • Impact on radiology of ordering by NPs and Pas
For a complete list of speakers and topics, hotel reservations and on-line registration
please use this link.