Archives     Advertise     Editorial Calendar     Subscribe     Contact Us    


Academy Offers Objective Actuarial Perspective on Surprise Medical Billing


 

As the national debate over addressing "surprise billing" of patients continues to unfold, the American Academy of Actuaries is offering an objective actuarial perspective on the financial consequences and considerations involved in proposed public policy solutions to the problem in a new issue brief.

"Policymakers who have put forward solutions generally agree with an approach of basic protections that should be offered to patients to prevent them from bearing the costs of unexpected balance-billing," said Academy Senior Health Fellow Cori Uccello, a member of the Academy's Health Practice Council, which authored the issue brief, Surprise Medical Bills: An Overview of the Problem and Approaches to Address It. Most surprise-billing proposals would hold consumers harmless by prohibiting balance billing and basing patient cost-sharing on in-network cost-sharing requirements.

Much of the policy debate surrounds how insurers would pay providers and how different approaches would affect health insurance premiums and patient access to care. "These approaches should also be assessed by whether they would help address the underlying market failures that led to the surprise-billing problem in the first place," said Uccello.

Two main approaches have emerged: a benchmark-rate approach and arbitration. The Academy explains that if a payment benchmark is set below the average in-network rate, it could lead to lower provider payments and premiums and could increase the incentives for out-of-network providers to join a network. Arbitration could put downward pressure on provider rates, but it is administratively burdensome and could result in even higher provider rates if providers increase charges to put themselves in a better bargaining position.

Read the issue brief and learn more about the Academy's work on surprise billing and other health policy issues under the "Public Policy" tab at actuary.org.

 
Share:

Related Articles:


Recent Articles

AMA Supports Congress Providing Much-Needed Relief to Physicians Working Through the Pandemic

CHICAGO -- The American Medical Association (AMA) strongly supports provisions in the Continuing Resolution that will offer relief to hard-pressed physician practices. Revisions to the Medicare Accelerated and Advance Payments program (AAP) will help keep doors open during the pandemic and continue to offer patients access at this time.

Read More

AMA Releases 2021 CPT Code Set

New updates to medicine's common language reflect burden relief, COVID-19 testing and tech-enabled medical services

Read More

Council on Aging Offers Helpline, Resources for Healthcare Providers

COA offers a helpline and lifeline to providers, older adults, caregivers and family members trying to navigate services.

Read More

VUMC Launches Groundwork for Tennessee's First Federally Funded Alzheimer's Disease Research Center

Angela Jefferson, PhD, professor of Neurology and director of the Vanderbilt Memory and Alzheimer's Center, has been awarded a grant from the National Institute on Aging (NIA), part of the National Institutes of Health (NIH), to support establishment of an NIA-funded exploratory Alzheimer's Disease Research Center (ADRC) at Vanderbilt University Medical Center (VUMC).

Read More

From Pain Management to Pandemic: The Changing Face of Sports Medicine

New norms mean new routines and standards of care on and off the field.

Read More

Kids, Classrooms and COVID-19

Risk mitigation key as kids hit the classrooms.

Read More

Meharry, Wharton Partner on Dual Degree Program

Meharry Medical College and the Wharton School at the University of Pennsylvania have partnered on a joint MD/PhD program.

Read More

Practice Management Q&A with NMGMA

NMGMA leaders answer questions about challenging practice management issues.

Read More

Physician Practice Leadership in a Post-COVID-19 Environment

COVID-19 has changed just about every aspect of daily life, including the way care is delivered. Looking toward a post-COVID landscape, practice leaders will need to reevaluate processes and assess the best way forward.

Read More

Economic Effect of COVID-19 Shutdowns & PPP Relief

A public health crisis, COVID-19 has also proven to be an economic crisis for practices and providers. For those receiving PPP relief, the path to forgiveness is coming into focus.

Read More

Email Print
 
 

 

 


Tags:
Healthcare Cost and American Academy of Actuaries, Surprise Billing, Surprise Medical Billing
Powered by Bondware
News Publishing Software

The browser you are using is outdated!

You may not be getting all you can out of your browsing experience
and may be open to security risks!

Consider upgrading to the latest version of your browser or choose on below: