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September 17, 2015   


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 CSP 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. Providers remain unhappy with an interim payment rate can 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 CSP will continue to push for a solution that does remove the patient from the dispute but also provides fair reimbursement to providers.

Upcoming Webinar:
Preparing for Part A Contract Negotiations
Including Performance Based Incentives

Available to both CSP members and nonmembers, on Thursday, October 1, 2015 at NOON PST, Senior Reimbursement Consultant, Robert H. Tessier with HBP Services, Inc. will establish a solid foundation for Part A payment and related contract negotiations. He will discuss how to develop a Fact Book and Timeline to help your practice adequately prepare for contract renewals; and defend efficient contract metrics including performance incentives for Part A support.
Cost: Member: $99/Non-Member: $149 
IMPORTANT: There is a 2-step registration process. After payment, you will be directed to register with GoToWebinar in the confirmation email sent by CSP. 

Register for the CSP 68th Annual Meeting

Over 250 pathologists, practice managers, residents, and exhibitor reps will convene in San Francisco to engage in insightful presentations and case studies. The 2015 Annual Meeting will cover several new techniques and our tutorials will offer excellent practical applications pathologists will use in their laboratories. 
CSP's 5-day educational program from December 1-5, 2015 at the Hyatt Regency San Francisco will feature Short Courses on:
  • Gastrointestinal Pathology   (Greenson and Yantiss)
  • Endometrioid Carcinoma   (Zaino, Mutch and Nucci)
  • Recent Pap Society Recommendations for Pancreatic and Biliary Cytology  (Layfield and Siddiqui)
  • Leukemia Classification from WHO   (Foucar)
  • Atypical Melanocytic Proliferations   (Binder and Smart)
Plus many more speakers presenting different topics with the microscope video tutorials, Special Lecture, Clinical Pathology Lecture and Saturday Case Seminar.



California Society of Pathologists
One Capitol Mall Suite 800
Sacramento, CA 95814 
Tel : 916-446-6001
Fax :  916-444-7462

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