October 12, 2016
Area(s) of Interest: AB 72 Payor Issues and Reimbursement Practice Management Out of Network Billing
In September 2016, Governor Jerry Brown signed into law a controversial bill (AB 72) that will change the billing practices of non-participating physicians providing non-emergency care at in-network hospitals, ambulatory surgery centers and laboratories.
While the enactment of AB 72 can never be described as favorable, the end result is a law that puts to rest the issue of so-called “surprise billing” in a way that preserves the ability of physicians to continue collecting their usual rate (as long as they obtain the consent of the patient), implements a statutory payment structure that borrows significantly from California Medical Association (CMA) policy and ensures that the statutory payment structure only applies in a narrow set of circumstances.
"Through our good faith participation in the AB 72 stakeholder process, CMA once again represented the true nature of physicians delivering care in a complex system," said CMA Senior Vice President of Government Relations Janus Norman, in his annual legislative wrap up. "We were able to convey that physicians desperately do not want patients to be financially injured by the profit-driven decisions of health insurers to narrow physician networks so that patients are barred from having a substantive opportunity to utilize their in-network benefits."
To help clarify the new law and to address physicians' concerns and questions, CMA has published, "A Physician's Guide to AB 72: Questions and Answers." The FAQ is available to members only.
CMA is also hosting a free webinar on October 19 that will provide an overview of the new law and help physicians understand the circumstances under which the bill applies, how physicians can continue to charge their usual and customary rates and how the bill provides an opportunity to improve network adequacy standards.