Notice to Patients Required for Outpatient Facility Fees

The Connecticut House of Representatives responded on Wednesday to medical billing concerns patients expressed over undisclosed and unexpected facility fees by unanimously passing a bill that requires notice. Many patients expressed that the additional charges were a surprise when they received their bill. The legislation now moves to the state Senate for a vote.

The charges, often referred to as "facility fees" are charged to patients by medical offices that are owned by hospitals for outpatient care. These fees are separate from doctor fees. Facility fees range from several hundred to thousands of dollars.

The bill to require notice to patients about fees possible extra charges for outpatient care at medical offices owned by hospitals. The bill specifically requires that patients with scheduled appointments at medical offices where facility fees are charged receive notice about the fees in plain language before they receive treatments scheduled so long as the appointment is scheduled at least 10 days in advance. If the exact nature of the services or insurance coverage is unknown the patients would be provided with an estimate based on typical charges at the facility. Notice for patients receiving emergency care would need to be delivered as soon as practicable after the patient is stabilized. The bill does not impact the offices' ability to charge facility fees.

Other provisions in the bill are include requirements that the office prominently displays that the facility is connected to a hospital, what hospital the office is affiliated with, and states that the patient may be incur higher charges than if they were treated at a facility that isn't hospital-based.

Enrollment in Health Insurance Reaches Surges to 8 Million

The Obama Administration released data showing that over the last six weeks a surge of 3.8 million Americans enrolled in private healthcare plans. That notable when compared to the 4.2 million individuals that signed up in the entire first five months after enrollment when the website was plagued with IT issues that impaired enrollment. The Administration explained that young adults comprise more than a quarter of the enrollees.

During the press conference President Obama emphasized that there are 5 million more people that would be eligible for health insurance in states that chose not to expand Medicaid. Leaders in those states commented that they were concerned about costs if Congress failed to maintain full federal funding as the law requires. 

ICD-10 Deadline Delay Slows Medical Billing Conversion

Medical billing codes are used by doctors, hospitals, and health insurance companies to track each patient procedure and ensure that the doctors are paid. The ICD-9 code has been in place since the 1970s. The ICD-9 was scheduled to be replaced with ICD-10 by October 2014. 

The conversion would add tens of thousands of unique codes to the medical billing structure, an increase to roughly 72,000 codes in ICD-10 from about 4,000 codes in ICD-9. Advocates for ICD-10 argue that the new coding system is necessary to modernize the billing code to capture the variety of medical treatments available now that did not exist in the 19070s.  Additionally, they argue that a more detailed code will allow for more precise medical research and data collection. 

Despite the benefits of moving to an ICD-10 medical billing system, the transition over the last five years has been difficult. In order for the transition to be smooth and successful all parties need to switch to the ICD-10 codes at the same time. Many smaller practices were not able to dedicate the training time and resources to complete the transition by October of this year. 

However, larger facilities, hospitals, and insurance companies with more resources were able to dedicate time and money to implementation measures and preparation. In fact, many have spent millions to train staff on the new ICD-10 billing codes. These facilities were relying on the statements by Health and Human Services representatives made as late as February 2014 that explained the October compliance date was firm. Questions remain about the implementation of ICD-10 at these facilities and whether these employees will need to be re-trained as the adjusted ICD-10 deadline nears.

Congress Passes Bill to Delay Medicare Reimbursement Cuts

On Monday evening the Senate passed and President Obama signed the Protecting Access to Medicare Act of 2014 (H.R. 4302) into law. This marks the 17th time Congress delayed the cuts to physician reimbursements established with the Sustainable Growth Rate under Medicare. The bill delays a 24% cut to the payments.

The Senate passed the bill with a 64-35 vote the evening the cuts were to go into effect at midnight. The Senate vote was preceded by the House passing the bill with a rare voice vote last week.  Both chambers moved quickly to pass this bill after it became obvious no agreement would be reached on how to pay for the permanent 'doc fix' bills.  

The Sustainable Growth Grate (SGR) was created in 1997 by Congress as a mechanism for tracking the payments with economic growth. The SGR became a problem within a few years as increases in healthcare costs substantially outpaced economic growth. This development resulted in the creation of a multi-billion dollar shortfall for the funding of Medicare payments to physicians. 

Members on both sides of the aisle and in both Chambers spoke about the need to permanently fix the SGR. However, they recognized the immediate need to prevent the delay's expiration and prioritized this temporary patch over a lengthy negotiation process to pass a  permanent fix that would result in the expiration of the SGR delay.