MGMA19: Senator predicts Congress will act on surprise billing before end of year

NEW ORLEANS—As members of Congress wrangle over the best way to stop surprise medical bills, one senator predicts Washington will pass a new law before the end of the year.

Speaking at the Medical Group Management Association’s (MGMA) annual meeting in New Orleans this week, Sen. Bill Cassidy, M.D., a Republican from Louisiana, who has thrown his support behind one solution to the surprise billing problem, predicted Congress will pass legislation by year’s end.

Surprise billing is the hottest topic when it comes to regulatory issues, getting the public’s and Congress’ attention with headlines, such as the cat bite that cost a patient $48,512 or a young camper’s $143,938 snakebite.

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“This debate is happening right now. I’m telling you this will be decided soon,” said Cassidy, a keynote speaker at the conference. Cassidy, who is a gastroenterologist, urged the audience to let their representatives in Congress know where they stand on the issue.

However, MGMA officials aren’t as optimistic about that timeline.

MGMA’s government affairs staff said they think it will be hard for Congress to pass a bill to resolve the surprise billing issue, especially as lawmakers are now caught up in a fight over impeachment hearings of President Donald Trump.

The MGMA, like many of other physician groups, is supporting the arbitration approach to surprise billing, which Cassidy supports. With surprise billing, patients receive care at in-network hospitals but then receive unexpectedly high bills because one or more of their clinicians was out of network.

Committees in the House and Senate have both advanced legislation that would prohibit balance billing, in which the provider bills the patient for what their insurance won't cover.

Congress is now debating two possible solutions. Both would make patients who receive such bills “held harmless” so they only have to pay their portion of the bill they would have paid if everything was in-network. The debate is over how the out-of-network physicians will be paid.

The arbitration approach is similar to one being used in New York state. If an out-of-network provider receives a payment from an insurer they think is unfair, the provider and insurer will go to a dispute resolution system and then to “baseball-style” arbitration if they cannot negotiate a settlement. Both the provider and payer submit the amount they want for an out-of-network charge and the arbitrator decides.

The other proposed solution, a Democratic bill put forth in the House of Representatives which is favored by insurance payers, would use a benchmark median rate for all out-of-network charges. The legislation, based on a California law, would allow insurance companies to base their payments to out-of-network providers on an insurer’s median in-network rate.

MGMA is strongly opposed to that approach, said Mollie Gelburd, J.D., an associate director of government affairs at MGMA, at a conference session updating members about issues now being debated in Washington. One provision in the proposed law rates to timely bills and would require providers to send in bills within 45 days after treatment. That’s unreasonable, she said, as practices encounter problems, for instance, when patients submit the wrong health insurance information.

But MGMA members also raised issues about how the arbitration proposal would work. One audience member said arbitration would be very expensive for practices. Under the proposal, the loser would pay for the arbitrator.

Gelburd agreed it is expensive whenever an organization needs to bring in an attorney, but she said arbitration would only be used as needed when both sides could not use negotiation to settle a bill.

Another audience member said in New York, arbitration is settled on a claim-by-claim basis. He suggested practices should be allowed to bundle claims. Otherwise, if a practice has a disagreement over a $50 claim, they are not going to spend thousands of dollars to arbitrate a bill, he said.

In his speech, Cassidy urged physicians and practices to speak up and help fix healthcare issues. “Unless we in healthcare, physicians and those who are so familiar with healthcare systems, bring our expertise to the public policy debate, we will end up with public policy that does not work,” he said.