Anesthesia Business Consultants President and CEO Tony Mira penned a blog post on how practices are adapting to recently passed balance billing laws.
Here's what you should know:
1. New York, Connecticut, Florida, Illinois, Maryland and California all passed laws restricting balance billing. Several other states have introduced bills that would restrict the practice as well.
2. Anesthesia practices covering one or more facilities have been entering into contract negotiations with payers who were previously out-of-network in an attempt to create in-network profiles for their facilities. Mr. Mira calls this the "most pragmatic and realistic path."
3. Mr. Mira suggests every anesthesia group should assess its contractual obligations and the payment policies of major payers.
4. In New York, some groups that haven't contracted with payers are fielding a high volume of claim-specific negotiated proposals from payers. Instead of having a contracted rate, these groups are negotiating on a case-by-case basis. ABC confirmed those case-by-case have had a "fair degree of success" with this practice. The practices receive a volume of claim-specific proposals and consistently receive the requested percentage of the usual charge
5. These restrictive laws have shifted power to payers, giving anesthesia groups little room to negotiate out-of-network. As anesthesia service rates increase, a typical PPO insurance plan reimburses up to 50 percent less than usual; resulting in drastically decreased reimbursement rates.
6. Despite the changes, Mr. Mira said anesthesiologists at busy facilities haven't seen a drop in income, but he warns downward pressure will continue to hamper reimbursement in the coming years.
Mr. Mira believes "the flexibility anesthesia care providers have previously enjoyed to successfully negotiate favorable contracts with insurers," has eroded with no signs of it returning in the future.
He continued, "This negotiating leverage helped anesthesia practices offset the negative impact of a growing population of lower-paying or no-paying patients. This scenario is changing as balance-billing laws have begun to upset the balance that existed in a free market."