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For those physician and supplier claims that were unassigned in 1990, the highest average beneficiary balance billing liability was noted for inpatient hospital ($321) and ambulatory surgical center ($290).
* A simulated balance billing cap of 109.25 percent in 1988 would have saved Medicare beneficiaries about $1.3 billion in balance billing liability; that is, the total balance billing liability would have amounted to $0.6 billion instead of $1.9 billion.
Although the balance billing portion of beneficiary liabilities increased at a faster average annual rate during the period 1975-87, 11.3 percent, than copayments (i.e., deductibles and coinsurance), 10.5 percent, balance billing dollar amounts per capita dropped sharply in 1987.
State legislatures are also likely to share Congress' views on RBRVS and BBC because of the budget neutral nature of those programs when combined with the VPS, because of the possible increased expenditures due to volume increases without VPS, and because of the political benefit from banning most balance billing.
The No Balance Billing Policy guarantees zero out-of-pocket on the part of the member when confined at the ward of any government facility.
Balance billing may rise to the top of state regulators' major medical insurance to-do lists, as they wait for the detailed reports they need to respond to how PPACA has affected health insurers' finances.
Under the "no balance billing" system, indigent patients should not pay a single centavo when they go to a public hospital, lawyer Alexander Padilla, president and executive chief officerof PhilHealth, told reporters after attending the hearing of the Senate committee on health.
The draft bill is intended to jumpstart discussions in Congress about how to best stop the use of balance billing to charge patients for emergency treatment or treatment provided by an out-of-network provider at an in-network facility.
CMS is asking for feedback on the information it should post on, but it suggests that it might post issuer-level enrollment data, issuer financial data from the previous year, and a link to a website an issuer will use to explain how it handles out-of-network claims and balance billing.
"The four centers will apply the 'no balance billing policy' with respect to kidney transplant patients from families earning P30,000 or less annually.
Anecdotally, it is clear that a greater share of this cost is being passed along directly to consumers through a practice known as balance billing, but GAO was unable to determine the prevalence of this practice because of a lack of data.
"Balance billing" often crops up when patients go to in-network hospitals, and then get care from out-of-network radiologists, out-of-network pathologists, or other out-of-network specialists.