Health

Anesthesiologists accuse Blues plan of abusing billing ban

The American Society of Anesthesiologists has accused the North Carolina-based Blue Cross Blue Shield of using the upcoming surprise billing ban as an excuse for strong on-net clinicians to cut rates.

The nonprofit payer, which has 3.8 million members, sent letters to 54 anesthesiologists, radiologists, emergency departments and other clinicians earlier this month, threatening to terminate their contracts if they would not agree to cut payments by up to 30%. In the letter, the payer said that the cut in payments is due to the Surprise Ban Act, which will take effect in early 2022.

HHS Lays Out Surprising Billing Problem Resolution Process In New Rule

With the legal deadline approaching, providers are scrambling to draw attention to the independent dispute resolution process to determine a fair market rate, which they say is giving insurers too much leverage. In October, CMS instructed arbitrators to base their respective off-chain rates based on the insurers’ median contract rate for the same service in a geographic area. The Congressional Budget Office believes the move to market prices will bring premiums down to 1%.

“I don’t think that when someone is reloading it will hurt the recharge, so now [accept] fair price, Health and Human Services Minister Xavier Becerra told Kaiser Health News. “Those who charge excessive fees either have to tighten their belts and do better, or they won’t last in business.”

HHS said it will consider commenting on the rule, which some 150 members of Congress say is contrary to the intent of Congress and should be changed.

Becerra says unexpected billing rules are forcing doctors who charge inflated fees to accept fair prices

“By definition, if they’ve been around for a long time, they should work both ways,” said ASA President Dr. Randall Clarke. “If health plans were to maintain an adequate network through objective measures, they would have to negotiate in good faith with doctors.” Providers such as ASA say giving insurers an edge will allow them to lower payment rates and crowd out doctors. networks and outside the business, which reduces the ability of patients to access the care they need. The Specialized Society, which represents 54,600 anesthesia providers nationwide, believes that long-term contracts between payers and providers should be maintained and that state and federal regulators should set network adequacy standards for insurers.

He said the ASA does not support vendor groups that go off-chain as a business strategy.

BCBS North Carolina said it sent out the letters to the state’s most expensive healthcare providers, who charged insurance company members up to 500% more than they billed Medicare patients, a spokesman said. The insurer said these methods represent a small percentage of the thousands of contracts it was able to negotiate at smarter rates.

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“Blue Cross NC is delighted that Congress has taken action to protect patients from unfair and costly medical bills, and we value the opportunity to get rid of patients and negotiate directly with the most expensive commercial providers,” the spokesperson said. “We are committed to doing everything we can to make healthcare more accessible to our members and more accessible to more people in North Carolina.”

Research shows that patients face a lot of unexpected anesthesiology bills, in part because they usually can’t choose their anesthesiologist. In 2015, 12% of on-net hospital bills included unexpected payments for anesthesia services, according to a Yale University study. The study found that these providers charge more than eight times the Medicare rates for their services.

“Medicare is an arbitrary system created by CMS, it is non-negotiable and has nothing to do with the cost of providing services in anesthesiology,” said Clark of the ASA. “If the Blue Cross Blue Shield of North Carolina or others interpret their new authority as an opportunity to move closer to Medicare rates, it will lead to major disruptions and a complete loss of services in many places that really need them.”


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