Review of balance billing law implementation

The Florida House of Representatives Health Market Reform Subcommittee is in the process of reviewing implementation of HB 221, which went into effect in 2017. The legislation banned balance billing in Florida. Since its implementation, we have seen repeated violations of the minimum reimbursement standard laid out in the legislation, in some cases resulting in drastically reduced payments to emergency physicians. FCEP brought the issue to the Office of Insurance Regulation last year, but OIR has not taken action to enforce the minimum reimbursement rate set in the statute. We are hopeful that the legislature will take action on this very important issue.

Centene violation of prudent layperson standard

In recent months, Centene has adopted a practice of using final diagnosis lists to down code emergency claims in several states including Florida. This policy violates federal and state prudent layperson standard laws, which prohibit the reduction of payment for emergency care based on final diagnosis. The laws also require the insurer to review the medical record before down coding a claim, which has not been Centene’s practice. ACEP and EDPMA are actively engaging with Centene regarding this practice. The issue has also been referred to the Florida Medicaid office.

Reimbursement and Innovation Summit

FCEP’s annual Reimbursement and Innovation Summit will take place February 27-28, 2020 at EMLRC/FCEP headquarters in Orlando. This conference highlights evolving EM payment issues and features nationally recognized reimbursement experts. Please join us in attendance.

EM Days

FCEP’s annual advocacy event, EM Days, will take place January 27-29, 2020 in Tallahassee. As usual, we are closely monitoring legislative developments. The legislature will likely revisit some bills of interest that did not pass last session, including those related to pharmacist and ARNP scope of practice and personal injury protection (PIP) insurance. We hope you can join us as we represent emergency physicians throughout the state. Please also consider donating to our PAC below.

Florida Healthcare Transparency Database

The long-awaited Florida healthcare transparency database, Florida Health Price Finder, launched in November. At present, it does not appear to include any information regarding emergency care. ■