Webinar: How to challenge the AB 72 interim payment for out-of-network services September 25, 2017 General, Managed Care AB 72, Out of Network Care, Webinars 0 On July 1, 2017, a new law (AB 72) took effect that changes the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor. Under the new law, plans/insurers are required to make “interim payments” to non-contracted physicians for covered, non-emergent services performed at in-network health facilities. The interim payment is the greater of either the plan/insurer’s average contracted rate or 125 percent of the Medicare rate. However, the new law does include mechanisms for physicians to challenge the interim payment. The California Medical Association (CMA) is hosting a free members-only webinar on the different options for challenging the interim payment on September 27, 2017. The webinar will include an overview of the dispute options, details on how the AB 72 independent dispute resolution process will work and CMA resources available to assist physician members. CMA has also published a number of resources to help physicians navigate this new system, including a sample letter physicians can use to appeal to the plan/insurer and an FAQ. These resources are available free to members only in our AB 72 Resource Center at www.cmanet.org/ab-72. CMA is aware of the potential adverse impacts of the new law on our physician members and has dedicated significant resources in order to achieve the best possible outcomes for physicians in light of the new billing restrictions. If your practice has experienced a change in payor behavior regarding contract negotiations, claims payment or network adequacy concerns, or is experiencing other challenges, CMA wants to hear from you. For more information, visit www.cmanet.org/ab-72 or call CMA’s Reimbursement Helpline at (888) 401-5911. Comments are closed.
