October 15, 2017
Area(s) of Interest: Practice Management AB 72 Out of Network Billing
The California Medical Association has published a workbook to help practices identify if payments they receive comply with AB 72's interim payment rules.
AB 72—California’s new out-of-network billing and payment law—requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for covered, non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in such circumstances to collect their full billed charges.
The interim rate defined in AB 72 is the greater of the average contracted rate (including only commercial contracts) or 125 percent of the amount that Medicare reimburses on a fee-for-service basis for the same or similar services in the geographic region in which the services were rendered.
The AB 72 Payment Monitoring Workbook is available free, to members only in CMA’s AB 72 resource center.
In CMA’s AB 72 resource center you will also find a number of other resources to help physicians navigate this new system, including an FAQ, a sample appeal letter, a guide to help physicians challenge “interim payments” and a series of on-demand webinars.
For more information, visit our Out-of-Network Billing page or call CMA’s Reimbursement Helpline at (888) 401-5911.