tci Medicare Compliance & Reimbursement - 2006 Issue 13

INDUSTRY NOTES: Court Rules In Favor Of ER 'Balance Billing'

Plus: Watch out for state, federal laws on charging patients interest and surcharges.Emergency room physicians who "balance bill" patients who belong to managed-care organizations are not breaking the law, a court ruled.When a managed-care patient comes into the ER, sometimes an emergency physician who belongs to that patients' MCO isn't available. In that case, the law requires a non-participating ER doc to treat the patient, and the MCO must pay the doctor.But the doctor doesn't have to accept the MCO's payment rate as payment in full, the Court of Appeals for the Second District of California...

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