Here are six things to know.
1. The legislation in question, Senate Bill 289, is sponsored by Nevada Sen. Joe Hardy, R-Boulder City.
2. Under the legislation, out-of-network physician reimbursement levels would be determined using an independent database of billing practices, according to the report.
3. Out-of-network physician reimbursement from insurers would be equal to the 80th percentile of charges billed by physicians for a particular service within certain geographical regions, the report states.
4. A patient who knowingly goes to an out-of-network physician or facility would not be affected by the bill, reports the Las Vegas Review-Journal.
5. The legislation drew a number of supporters, including physicians. “There is a transparency problem in the industry that has led to gross misperceptions regarding out-of-network billing events,” emergency physician Bret Frey, MD, said in a written testimony, according to the report. “If a patient purchases an insurance product with a narrow network, they generally will end up out of network in an emergency, through no fault of their own, because they have a condition that by its nature demands a very specialized level of care, such as stroke, heart attack and trauma.”
6. But insurers are not as keen on the bill. According to the report, they claim the legislation would lead to higher premiums and copays. Nevada Association of Health Plans representative Keith Lee said setting geographical rates could cause providers to forgo negotiations and exit networks.
More articles on healthcare finance:
5 latest hospital, clinic closures
Hedge fund looks to take control of Adeptus Health as bankruptcy looms
$1M infusion allows California hospital to avoid closure — for now
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.