Trump executive order to ban all balanced billing

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linkin06

linkin06

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The Texas Society of Anesthesiologists has learned that President Trump will announce an Executive Order today during a rally in North Carolina (3:30pm CTZ) which will ban balance billing for all out-of-network physicians and set reimbursement at Medicare rates.

Our understanding of the Executive Order is that all hospitals participating in Medicare will be required to ensure adequate access to in-network physicians as a condition of their participation. All out-of-network procedures will be reimbursed at Medicare rates. Since it is tied to the hospital’s condition of participation, we are concerned this would apply to federal and state regulated insurance plans.
 
msnbc2020 said:
I understand what balanced billing means and that it will be banned. For those of us who are unenlightened and ignorant, can you explain what the net overall effect will be regarding physician revenue?
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People say insurance companies will opt out of network and then get Medicare rates
 
From an email from the Texas Society of Anesthesiologist...

"The national organized medicine associations are discussing legal actions to prevent the implementation of this overreach by the Executive Branch"
 
www.commonwealthfund.org

State Balance-Billing Protections

This interactive map allows you to click on a state to learn how it protects consumers against balance billing.
www.commonwealthfund.org www.commonwealthfund.org

This website has a pretty good map of all states and the way they do it. Am I missing something with this executive order? It'll just be nation wide after he signs it right.
 
msnbc2020 said:
I understand what balance billing means and that it will be banned. For those of us who are unenlightened and ignorant, can you explain what the net overall effect will be regarding physician revenue?
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It’s a race to the bottom leading to Medicare type rate contracts with insurance companies as physicians no long have any leverage to negotiate with said Insurance companies. It’s honestly worse than just a straight forward Medicare for all plan pushed by some Democrats.
 
Depending on the wording of this order, it could be the death blow to medicine. If this extends to outpatient private practices (I'm psych), I'll probably close up shop and be a goat farmer.
 
“On call just now HHS Sec Azar makes clear Trump’s forthcoming executive order on preexisting conditions will not carry weight of actual law should SCOTUS strike down the ACA. Said it is a "defined statement of U.S. policy that people with preexisting conditions are protected."


so it’s basically a tweet
 
Sushirolls said:
Depending on the wording of this order, it could be the death blow to medicine. If this extends to outpatient private practices (I'm psych), I'll probably close up shop and be a goat farmer.
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Or you know, just do cash.
 
He's just trying to cater to his base before the election to make it seems like he cares about our health care needs. Per the article below, it seems he's also signing an order to protect pre-existing conditions, and that the one in regards to balanced billing, is merely aimed at bringing it to attention to get something done soon.

I do think it helps to fear monger, as most docs have little clue about balanced billing, the proposed solutions, and how it could affect their practice.

www.fiercehealthcare.com

Trump signs executive orders on preexisting condition protections, surprise billing

President Donald Trump signed an executive order today that declares it a national policy to protect patients with preexisting conditions regardless of the fate of the Affordable Care Act (ACA)—but | President Donald Trump will sign an executive order today that declares it a national policy to...
www.fiercehealthcare.com www.fiercehealthcare.com
 
Thanks to pushback against the White House’s planned Executive Order which would have banned balance billing and instituted a Medicare rate for all out-of-network care, President Trump changed courses this afternoon.

Ultimately, the President announced an Executive Order which sets a deadline of January 1, 2021 for Congress to pass a federal balance billing legislation and if they fail to meet that deadline, the President will direct Health and Human Services Secretary Alex Azar to explore executive actions to end surprise medical billing.
 
I wonder if he’s going to get enough push back in regards to his planned "born alive" executive order. Ha, yeah right.
 
NontradCA said:
Or you know, just do cash.
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A cash only practice for some is essentially an out of network balance billed practice. Wording would determine the impact if extend into outpatient OON practices or even those who attempt to be pure cash only no OON billing.
 
linkin06 said:
Thanks to pushback against the White House’s planned Executive Order which would have banned balance billing and instituted a Medicare rate for all out-of-network care, President Trump changed courses this afternoon.

Ultimately, the President announced an Executive Order which sets a deadline of January 1, 2021 for Congress to pass a federal balance billing legislation and if they fail to meet that deadline, the President will direct Health and Human Services Secretary Alex Azar to explore executive actions to end surprise medical billing.
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You mean he didn't think this through first? Shocker...
 
if this passes, what is preventing medicare from paying us nothing? or 0.01 CENTS (0.0001 dollars) per RVU.
 
Trump is a bull in a china shop. He doesn’t understand or care to understand why and how OON billing came to be. He offers a solution that appeals to his populist base and others without any consideration to the reasons why things are the way they are.
 
nimbus said:
Trump is a bull in a china shop. He doesn’t understand or care to understand why and how OON billing came to be. He offers a solution that appeals to his populist base and others without any consideration to the reasons why things are the way they are.
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That’s really his approach for everything to be honest.
 
msnbc2020 said:
Any legal action will provide big-time ammunition for those advocates who complain that physicians care more about $$$ than patients.
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People hate doctors and bean counters won’t sleep until you’re working for free.

At this point who cares what the optics are, what are your options. Just sit there and take it?
 
0kazak1 said:
if this passes, what is preventing medicare from paying us nothing? or 0.01 CENTS (0.0001 dollars) per RVU.
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Probably their credibility as a health insurance program so 0.01 cents/RVU is a distant inflation adjusted goal Ofcourse
 
txhorn said:
Medicare for all without the universal coverage. Thanks for the brilliant plan, Trump.
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The twin nightmares of bleeding heart liberalism and bean counting fiscal conservatism. All the work of keeping humanity health without the pesky issues of paying for it! Haha
 
OON charges are out of control and frequently not disclosed to the patient before such charges are incurred. A PA assistant trolls the local ORs asking if the surgeon needs assisting on the case- of course the surgeon says yes, since it gets him out of the OR more quickly and can have another patient brought into another OR, prepped and ready for surgery. However neither the independently billed PA charge out of network is discussed nor their participation in their care in advance.
 
Aether2000 said:
OON charges are out of control and frequently not disclosed to the patient before such charges are incurred. A PA assistant trolls the local ORs asking if the surgeon needs assisting on the case- of course the surgeon says yes, since it gets him out of the OR more quickly and can have another patient brought into another OR, prepped and ready for surgery. However neither the independently billed PA charge out of network is discussed nor their participation in their care in advance.
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As well intentioned as the measure will be, this will have more consequences for providers who get screwed despite playing by the rules.
 
Surprising billing is BS. So what's the solution so doctors don't get shafted?? Increasing reimbursements which other parties (insurance) and probably CMS doesn't want to happen... So in the end, doctors will get shafted and life moves on... tragic.
 
I don't buy the argument that no OON billing means that insurers won't negotiate with physician groups. Right now the threat is "negotiate with us or we'll be OON and charge your patients up the a** if they see us" After this order, if it stands, why wouldn't you just say "negotiate with us, or we will refuse to care for your patients outside of emergent situations"

As a surgeon, I already don't see OON patients unless they cash pay. Now if the amount I charge them is limited to medicare, I can choose to accept medicare rates or just not see them if not an emergency.

It is certainly trickier for anesthesiologists, who don't choose the patients getting surgery, but can be done. The group just needs to coordinate with the hospitals where surgeries are performed and be in and out of network at the same places. Make acceptance of the hospital and anesthesia group in network essentially a packaged deal.
 

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Schumer needs to adopt this NY state law as the National one. Ironic since it’s his home state and the law actually works well.
 
linkin06 said:
People say insurance companies will opt out of network and then get Medicare rates
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And medicare rates for anesthesia, unlike other specialties (but still not great for others) is **** poor
 
Would you support a universal health care plan that would pay an average blended unit that was median private level? I guess Medicare would still stay Medicare though.
 
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