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Surprise Billing Legislative Alert

06/05/2019 4:08 PM | Deleted user

Dear WSP members,

The following alert was recently forwarded by CAP regarding out of network billing legislation.  This is a critical time period and our field needs all pathologists to participate in grass roots efforts to inform our congressional representatives about our concerns. Please take a few minutes to read the alert below and follow the link to CAP's PathNET action center to email your congressional representative. From this link, CAP members should be able to enter their email and zip code that will generate a pre-populated letter that can be customized if desired and subsequently forwarded to your congressional representatives.

WSP has also partnered directly with CAP drafting a written response to congress about our concerns.  In addition, Wisconsin Medical Society is working on the issue on behalf of Wisconsin hospital based physicians, including pathologists.

Thank you for your time. Please forward any questions or concerns.

From CAP:

You may have seen Congress is quickly advancing surprise medical billing legislative proposals at an alarming rate without properly vetting the potential consequences it could have on your ability to treat patients. Below is a quick recap:

  • There were several bills and drafts introduced to address surprise billing in both the House and Senate that the CAP has significant concerns with. These legislative proposals include the use of an out-of-network payment methodology exclusively tied to median in-network-rates which is unnaceptable to the CAP. It allows health plans to unilaterally determine the value of physician services and will turn the physician component of hospital care over to their financial control. That is a solution that will only benefit the health insurance industry to the detriment of the health care delivery system, and as such, is opposed by the CAP. The CAP cannot support any proposal that supports that provision.
  • Physician members of Congress, led by Reps. Raul Ruiz (D-CA) and Phil Roe (R-TN), released an outline for legislation that is a positive step in the right direction. As we’re encouraged by the direction of the outline by Reps. Ruiz and Roe, we need you to support them by using the buttons below to contact your member of Congress.

The solutions as proposed by Dr. Ruiz and Dr. Roe would take necessary steps to accomplish our goals of holding patients financially harmless from surprise medical bills while creating a fair reimbursement system that keeps patients out of the middle of billing disputes. In particular, the CAP is pleased to see inclusion of a baseball-style arbitration process that allows consideration for a range of factors, including the usual and customary rate that reflects the market value of physician services. 

While we are still hopeful that any final proposal will include network adequacy provisions, this is a far better starting point than other proposals we have seen.

Make your voice heard on this important issue that may permanently affect your payment and potentially limit patient access to your services. We look forward to advocating for the Ruiz-Roe proposal to be adopted in place of legislation adverse to pathologists. 

To contact your legislatures, click on the following link:

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