This week, the Alliance of Specialty Medicine, of which ASCRS is a member, sent feedback to the Senate Committee on Health, Education, Labor, and Pensions (HELP) on the bipartisan discussion draft—the “Lower Health Care Cost Act of 2019”—aimed at reducing costs and improving transparency in healthcare.
In our comments, we opposed the proposed requirement that physicians send all bills to a patient within 30 business days, because it is an insufficient timeframe for a provider to obtain all of the necessary information from the insurer to determine any balance to be paid by the patient. According to the proposal, providers would not be eligible for payment outside of the 30-day window, and if they billed outside that window, would face a civil monetary penalty of up to $10,000 a day.
Furthermore, we opposed the proposed policy that would make physicians responsible for ensuring accuracy of insurers’ provider directories. The proposal protects patients from cost-sharing in excess of in-network cost-sharing if they rely on the directory, regardless of whether the provider’s network status or information is incorrect, at the time services were provided. If the information is incorrect and the provider submits a bill to an enrollee with that excess amount, and the enrollee pays the bill, the provider must reimburse the enrollee (who relied on the directory) for the excess amount, plus interest. In addition, the provider may be subject to a penalty of up to $10,000 for each violation. We believe it is the responsibility of the plan to ensure the accuracy of its directories, not the provider.
We will keep you updated.