January 03, 2018
Area(s) of Interest: AB 72 Payor Issues and Reimbursement
Effective July 1, 2017, California’s new out-of-network billing and payment law (AB 72) 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 is the greater of the payor’s average contracted rate or 125 percent of the amount that Medicare reimburses on a fee-for-service basis for the same or similar services in that geographic region. This law also includes a mechanism for physicians to challenge the interim rate using the “Independent Dispute Resolution Process.”
To learn more about this law, find out if payors are reimbursing you correctly under AB 72, and learn how to dispute the interim rate, visit the California Medical Association’s (CMA) AB 72 Resource Center.
To talk to CMA’s reimbursement experts, call (800) 786-4262 or email firstname.lastname@example.org.