Network Billing Legislation Experience in Colorado November 6, 2019 - - PowerPoint PPT Presentation

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Network Billing Legislation Experience in Colorado November 6, 2019 - - PowerPoint PPT Presentation

APCD Support for Out-of- Network Billing Legislation Experience in Colorado November 6, 2019 Colorado House Bill 19-1174 Whats included? Services by out-of-network providers in in-network facilities Out-of-network emergency


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SLIDE 1

APCD Support for Out-of- Network Billing Legislation

Experience in Colorado

November 6, 2019

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SLIDE 2

Colorado House Bill 19-1174

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  • What’s included?
  • Services by out-of-network providers in in-network

facilities

  • Out-of-network emergency services – facility and provider
  • Payment based on greater of carrier-specific rate or CO

APCD 60th or 50th percentile allowed amount

  • Methodological challenges
  • Insufficient volume of services
  • Anesthesiology services – problems with volume,

inconsistent definition of unit values

  • Emergency services – bundled payments; defined

differently by payer

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SLIDE 3

“Getting to Yes”

  • Players
  • Colorado Division of Insurance
  • Colorado Association of Health Plans
  • Provider organizations
  • Anesthesiology – US Anesthesia Partners
  • Colorado Medical Society
  • Independent Surgical Assistants
  • Implementation Challenges
  • Slow pace of developing necessary regulations
  • No forum for sustained discussion and resolution
  • f questions about methods

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