State-level issues
FCEP continues to advocate for a solution to regulatory loopholes related to the 2016 balance billing legislation. After successful action by emergency physician groups to collect payment via the state independent dispute resolution process (administered by MAXIMUS), insurers are now choosing to opt out of the process, which exists to settle disputes regarding fair out-of-network reimbursement. You can read more about this in the next article.

In the 2021 legislative session, we anticipate legislation addressing personal injury protection (PIP) coverage, which is currently required by the state and helps cover medical bills after auto accidents. PIP (also called “no-fault” insurance) provides critical reimbursement for auto-related trauma care, including payment to emergency physicians. If PIP is repealed, emergency physicians could see a significant reduction in trauma-related reimbursement.

Federal issues
The 2020 Year-end Congressional package addresses Medicare cuts and surprise billing. Emergency physicians initially faced a 6% cut in Medicare reimbursement but, thanks to aggressive advocacy efforts by ACEP, a 2% or less decrease is anticipated (depending on code mix). The federal surprise billing legislation applies to ERISA plans (employer self-funded) and will not apply to state-regulated plans in Florida due to pre-existing state-level balance billing legislation. Key features include a requirement for deductibles for out-of-network emergency care to be the same as for in-network, a requirement for insurers to respond within 30 days of an OON claim with payment or denial, and an independent dispute resolution process that has no minimum dollar threshold and prohibits the consideration of usual and customary charges, billed charges, or Medicare amounts.

FCEP’s Insurance Summit
FCEP’s first-ever Insurance Summit was held virtually on December 9, 2020. Other specialty groups and medical societies were invited to give presentations detailing the obstacles to proper reimbursement by insurers that they are experiencing. This prompted passionate discussion amongst physicians from multiple specialties, including EM, rheumatology and orthopedic surgery. We look forward to working closely with our colleagues throughout the house of medicine to continue to fight bad-faith insurer tactics. ■