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Legislation Taking Effect July 1, 2016 - What Physicians Need to Know

Tuesday, June 28, 2016   (0 Comments)
Posted by: Diane Berg
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Legislation Taking Effect July 1, 2016 - What Physicians Need to Know
There are a number of bills passed during the 2016 Florida Legislative Session that are due to take effect on July 1st, 2016. There are 4 bills in particular that will have some impact on our members that warrant some discussion so you are prepared. Those issues are listed below and summarized further in this email.
  1. Transparency
  2. Workers Compensation Fee Schedule
  3. Out of Network Billing.
  4. PA and ARNP Prescribing Controlled Substances
1. Transparency - (HB 1175 can be downloaded here)

The notice that the Board of Medicine distributed concerning physician obligations due to the Transparency Legislation that passed this legislative session, HB 1175, can bedownloaded here. The bill does take effect on July 1, 2016. A copy of the entire bill can be downloaded above. And a summary of the various impact of the legislation on different stakeholders in the system can bedownloaded here.

As you will see, the impact of the new law for physicians primarily focuses on the provision of written estimates and financial policies when providing non-emergency care in a facility. However, Florida already has a Patient Bill of Rights that also requires physicians to provide a written estimate of charges upon request as well as other rights that patients enjoy. That language already in the statutes concerning a written estimate is as follows:

381.026(4) (c)(5) A health care provider or a health care facility shall, upon request, furnish a person, before the provision of medical services, a reasonable estimate of charges for such services. The health care provider or the health care facility shall provide an uninsured person, before the provision of a planned nonemergency medical service, a reasonable estimate of charges for such service and information regarding the provider's or facility's discount or charity policies for which the uninsured person may be eligible. Such estimates by a primary care provider must be consistent with the schedule posted under subparagraph 3. Estimates shall, to the extent possible, be written in language comprehensible to an ordinary layperson. Such reasonable estimate does not preclude the health care provider or health care facility from exceeding the estimate or making additional charges based on changes in the patient's condition or treatment needs.

That entire existing statute the comprises the Florida Patient Bill of Rights can be
downloaded here.

Our recommendation would be that you have one process in place to manage the provision of written estimates and financial assistance policies that meet these requirements of the current law as well as the new law, regardless of site of service.

2. Workers Compensation Physician Fee Schedule -
(the new fee schedule can be downloaded here)

After eight years of waiting, a new Workers Compensation Fee Schedule for physicians will take effect on July 1, 2016. The new fee schedule can be downloaded from the link above. The new fee schedule did not alter the statutory formula for reimbursement in Workers Compensation. The formula remains 110% of Medicare for Non-Surgery and 140% of Medicare for Surgical Procedures. The new law does allow the Division of Workers Compensation to calculate that formula based on updated Medicare values. Since it is a Medicare based framework, each CPT code will be impacted differently based on how the values have changed over the eight years since the fee schedule was last updated. According to NCCI, The overall impact in medical service expenditures due to the updated fee schedule is a 10.6% increase.

Physicians will want to look at their specific utilization of services in Workers Compensation to determine the overall impact to your practice.

This is also a good time to remind you of the purpose of the column in the Workers Compensation fee schedule that is labeled "2003 MRA" which is the Maximum Reimbursement Amount in 2003. The reason that 2003 MRA Column is included in the fee schedule is because back in 2003 when the Legislature passed the last major Workers Compensation Reform, language was placed in the statutes that would prevent reimbursement for any code from going below what the reimbursement amount was back in 2003. Part of the intent of the legislation in 2003 was to increase access to care for injured workers as reimbursement had fallen to a level where many physicians discontinued participating in the system. Therefore, the statutes provide that reimbursement will be the formula based on Medicare (110% for non surgery and 140% for surgery) or the 2003 MRA, whichever is higher. Physicians will want to monitor some codes that have been decreased over the years to determine if this 2003 payment reduction threshold will be triggered so you can make sure you are receiving the higher amount.

3. Out of Network Billing - (HB 221 can be downloaded here)

HB 221, Out of Network Billing, also takes effect on July 1, 2016. This legislation includes the ban on balance billing for PPO patients in the emergency setting and for all patients in an In-Network Facility when the physician is out of network and the patient has no choice but to use an out of network physician. A summary of the legislation can bedownloaded here. HB 221 maintains a "charge based standard" for out of network care. The legislation defines Usual & Customary Charges as follows: "The usual and customary provider charges for similar services in the community where the services were provided."

The legislation builds upon the existing dispute resolution process that Out-of-Network physicians can use if they feel the insurance carrier has not paid them the Usual & Customary Charges in the community. There are a number of sources of charges that are available to physicians and the public. One such example is: Physicians should avail themselves of these charge based comparison tools if they intent to challenge a Usual & Customary Charge payment through the dispute resolution process. Our organization will continue to work with our members to prevent insurance carriers from violating the intent of this charge based standard.

For in-patient non emergency care where patients have a choice of physicians to render care, our organization recommends that physicians inform patients of their network status where possible and try to get in writing that they are aware you are out of network prior to rendering a service and that the patient understands they may be balance billed depending on what their insurance company allows.

4. PA and ARNP Prescribing - (HB 423 can be downloaded here)

While HB 423 takes effect on July 1st, the Board of Medicine has stated (attached)that according to the law PAs and ARNPs cannot start writing prescriptions until January 1, 2017. Since there has been confusion on when these professionals can start writing, the Board has made it very clear with that statement on their website that January 1, 2017 is the date.
The statement from the Board of Medicine can be found here:

The Board of Medicine document linked above and attached is the key document to review as you prepare your Physician Assistants for this new capability to prescribe. It discusses limitations of their authority as well as educational requirements, etc. If you have ARNPs you need to monitor announcements from the Board of Nursing as well as the statement from the Board of Medicine.

Please pay attention to the limitations imposed on these professionals in terms of prescribing controlled substances since they are doing so under the supervisory relationship established with their physician.

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