Expect the New Law to Provide Ammunition in Medical Billing Dispute Litigation
Authored by Marcus & Manning, P.A. Partner Andrew Marcus
Deputy Secretary of the Florida Agency for Health Care Administration, Molly Mckinstry, provided an update to the Florida House of Representatives Health and Human Services Committee on the implementation of House Bill 1175, Transparency in Health Care, which passed during the 2016 session.
The legislation does several things. First, it creates an all payer claims database which requires doctors, hospitals, health insurers, and other health care entities to report the actual amounts paid for medical services procedures. Second, it requires health care providers and facilities to provide consumers with access to more information when they are billed for services and procedures.
AHCA has already established the Florida Health Finder website which provides consumers with certain health quality metrics for providers as well as their charges for many types of procedures at a variety of health care facilities. However, there is often a substantial difference between what a health care provider originally charges and what is ultimately paid by the consumer or insurer.
Ms. Mckinstry noted that a notice of award was provided to HCCI, a company with experience providing nationwide all payer claims databases. She also noted that HCCI had a website framework built and that they have significant claims data on the national level.
Once the website is finished, a consumer will be able to look up procedures or services and see the average Florida and national amount paid for them. In the future, consumers will be able to retrieve claims data from their local health care facilities and providers as well as certain health care service quality metrics, like the frequency of hospital readmissions.
Ms. Mckinstry was ambivalent regarding the effect of the legislation on the costs of care. However, she believed that the tool may help consumers or employers reduce their costs by finding more cost effective care.
Additionally, this tool may have a significant impact on some billing disputes between insurers and health care providers. In certain situations, insurers are required to pay a health care provider "the usual and customary provider charges for similar services in the community where the services were provided." A database with most, if not all, charges provided in a community will allow the parties to determine more easily and accurately what constitutes a usual and customary provider charge.
AHCA plans to release the first version of the website in July 2017 of this year. Local level data is expected to come in January of 2018.