Legislation and Regulatory
Important Advisory on Balance Billing By Non-Contracted Hospital Based Physicians
We have informed you that the Department of Managed Health Care (DMHC) has adopted regulations that make balance billing by a non-contracted hospital based physicians of Knox-Keene plan enrollees or patients an unfair billing practice. The regulations define balance billing as an unfair billing practice and the prohibition only applies to �??emergency services�?? in the hospital setting.
The regulations were approved on September 15, 2008 and will take effect on 10/15/08. A lawsuit has been filed in Sacramento by the CMA and other specialty societies to attempt to have the regulation declared invalid. A hearing will be held on November 21, 2008 so the regulation will be in effect for several weeks before the lawsuit could have any impact.
Click here to obtain a copy of the California Medical Association's Balance Billing Advocacy Toolkit. This document answers many of the practical questions as to what physicians should do as of 10/15/08 and the nature of the litigation. There are many practical issues so you should this information with your billing staff or company.
We will keep you informed of any developments.