Becker's Hospital Review

26 CFO / FINANCE 6 state bills targeting balance billing in Q1 By Morgan Haefner H ere are six bills addressing surprise bill- ing that were proposed, approved or moved through state legislatures during the first quarter of this year. 1. Colorado lawmakers introduced a bill that would require freestanding emergency rooms and urgent care centers to disclose pricing to patients right away. Senate Bill 18-146 would en- sure freestanding ERs are immediately transpar- ent with patients about cost and treatment op- tions and whether or not they accept insurance. 2. New Hampshire representatives overwhelm- ingly supported House Bill 1809, which passed the House March 6. e bill states providers performing "anesthesiology, radiology, emer- gency medicine, or pathology services shall not balance bill the patient for fees or amounts other than copayments, deductibles, or coinsurance, if the service is performed in a hospital or ambu- latory surgical center that is in-network under the patient's health insurance plan." e bill still requires Senate approval to become law. 3. In New Jersey, lawmakers introduced Assem- bly Bill 2039. e bill aims to shield consumers from out-of-network bills when they medically need emergency services or inadvertently re- ceived out-of-network care. Democratic New Jersey Gov. Phil Murphy is backing the legisla- tive efforts. 4. House Bill 2339 passed the Oregon legisla- ture last year and took effect March 1. Under the legislation, healthcare providers are prohibited from charging patients out-of-network rates for care provided at in-network facilities. 5. Washington senators didn't approve House Bill 2114 aer it passed in the state's House of Representatives. e bill would have protected consumers from receiving a surprise medical bill aer seeing an out-of-network provider at an in-network facility. 6. In Virginia, House Bill 1584 addresses balance billing by an out-of-network provider of ancil- lary service. e measure, which takes effect Jan. 1, 2019, states a "covered person shall not owe or be liable to the out-of-network provider for the ancillary services any more than the allowed amount; and the out-of-network provider shall not balance bill or collect any amount from the covered person for the ancillary services except for the allowed amount." n New York hospital seeks critical access status to jump-start finances By Morgan Haefner C obleskill (N.Y.) Regional Hospital is applying for critical access hospi- tal classification to turn around its widening deficit, The Daily Gazette reported. The hospital, part of Cooperstown, N.Y.-based Bassett Healthcare Network, said the designation would infuse $3.5 million a year into the facility, which is operating at a $2.5 million deficit on a $27 million annual budget. Coble- skill Regional Hospital blames its nearly 10 percent loss margin on multiple factors, including the exit of a medical provider who generated clinical and surgical visits for the hospital. To qualify for CAH certification, which will allow Cobleskill Regional Hospi- tal to collect 101 percent of Medicare, the hospital must decertify 15 of its 40 beds to meet CMS' 25-bed limit on CAH hospitals. Hospital President and CEO Eric Stein told The Daily Gazette the hospital has less than a 50 percent occupancy rate, only filling 26 of its beds now. n Urgent care claims jump over 1000% from 2007-16 By Megan Knowles P rivate insurance claim lines for urgent care services grew 1,725 per- cent from 2007-16, a growth rate more than seven times the rate for emergency room claim lines (229 percent) in the same time period, according to FAIR Health. For the report, FAIR Health gathered data from its database of over 25 bil- lion privately billed healthcare claims. "In a time when healthcare spending accounts for almost 18 percent of the nation's gross domestic product, and the healthcare ecosystem is undergo- ing rapid evolution, we hope that these new tools will inform decision making by all healthcare stakeholders, including payers, providers, government of- ficials, policy makers and others," said FAIR Health President Robin Gelburd. Here are six findings from the report. 1. In retail clinics and urgent care centers in 2016, acute respiratory infec- tions were the No. 1 diagnostic category. 2. For telehealth services, mental health-related diagnoses ranked No. 1. 3. The median charge for a 30-minute new patient office visit in 2016 ranged from $109 in a retail clinic, to $242 in an urgent care center to $294 in an office visit. 4. In 2016, for every adult age group, more claims were submitted for wom- en than men across all care locations. 5. From 2007-16, claims for ambulatory surgery centers jumped 127 per- cent in rural areas and 95 percent in urban areas. 6. The median billed charge for evaluation and management services in a hospital increased 28 percent from 2012-16. In the same time period, al- lowed amounts for E&Ms in a hospital setting, which reflects the maximum amount an insurer will pay for a service, grew 26 percent. n

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