decisionhealth Newsletters, Part B News - 2016 Issue 12 (December)
Out-of-network doctors’ obligations grow under state ‘surprise billing’ laws
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Article Overview
This article explains how several states are addressing surprise billing and balance billing through disclosure and notice requirements for out-of-network care. It is relevant for physician practices, hospitals, ambulatory surgery centers, and compliance staff who need a broad view of state-level patient notification obligations, cost-estimate expectations, and emergency-care exceptions. The discussion also points readers to selected state legislative and statutory sources for further review.
Why This Topic Matters
State surprise-billing rules can change how providers communicate network status, estimated charges, and patient consent before scheduled care. Understanding these obligations helps practices reduce compliance risk and prepare for varying state-specific requirements.
Article Sections
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Patient encounters
Introduces the topic of out-of-network disclosure in the patient care setting and frames it within broader surprise-billing concerns.
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Other states are following suit
Summarizes examples of state-level disclosure and notice requirements and notes that approaches vary by jurisdiction and payer type.
What You Will Learn
- How state surprise-billing laws affect out-of-network disclosure duties
- Which types of providers and facilities may be affected by these laws
- The general kinds of patient notice and cost-estimate obligations discussed in the article
- How state approaches to balance billing and surprise billing can differ
- Why practices should monitor state-specific legislative and regulatory developments
Who Should Read This
- Physician practices
- Hospitals
- Ambulatory surgery centers
- Compliance professionals
- Medical billing staff
- Health law and revenue cycle professionals
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