Monitor Mondays

Yea or Nay? Surprise Balance Billing Legislation Heads for a Vote

June 24, 2019
Monitor Mondays
Yea or Nay? Surprise Balance Billing Legislation Heads for a Vote
Chapters
Monitor Mondays
Yea or Nay? Surprise Balance Billing Legislation Heads for a Vote
Jun 24, 2019
Chuck Buck | Ronald Hirsch, MD | Knicole Emanuel, Esq. | David Glaser, Esq. | Angela Phillips, PT | Andrew Wachler, Esq. | Ellen Fink-Samnick | Matthew Albright
Hearings have made the industry battle lines clearer, in terms of how the various industry sectors think that out-of-network providers should be compensated by payors.
Show Notes

U.S. Sen. Lamar Alexander (R-Tenn.), chair of the Senate Health Committee, appears to be ready to shepherd his 165-page draft legislation on surprise balance billing for a vote next week. 

In their push to get legislation prohibiting such billing through before the August recess, both the House and Senate have held hearings in the past two weeks on the various approaches to the problem. Those hearings have made the industry battle lines clearer, in terms of how the various industry sectors think that out-of-network providers should be compensated by payors. 

Although no single approach appears to be significantly favored at this point, Matthew Albright, former Centers for Medicare & Medicaid Services (CMS) official reports the lead story during this edition of Monitor Mondays. 

Other segments to appear during the live broadcast include:

  • RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.

  • SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention.

  • CMS/IRF Settlement:  As reported by RACmonitor, the Centers for Medicare & Medicaid Services (CMS) agreed last week to settle appeals for inpatient rehabilitation facilities (IRFs) following a two-year dispute with the industry. Reporting on this developing story will be Angela Phillips, president of Images & Associates, and one of the nation’s foremost IRF authorities.
  • News from OMHA: The Office of Medicare Hearings and Appeals (OMHA) has expanded its Settlement Conference Facilitation (SCF) program, and it is now open to the appellant community. Healthcare attorney Andrew Wachler, a managing partner at Wachler and Associates, reports on how these expanded eligibility requirements provide new opportunities for appellants. 

  • Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.
    Links from David's segment: 
  • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.


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