AMA to write balance-billing legislation

The Association wants doctors to be able to bill patients for costs not covered by Medicare or other payers.

By David Glendinning, AMNews staff. July 11, 2005.

Chicago -- The solution to inadequate physician reimbursement is simple to some doctors: Bill the patient for any costs that are not covered by the insurer. But physicians need to be successful with a newly approved AMA initiative on Capitol Hill to have the ability to do that.

The American Medical Association, which has long supported the concept of "balance billing," decided at its Annual Meeting in June to prepare federal legislation that would allow physicians to recoup their costs from the patient regardless of primary payer. Medicare and most private insurers currently prohibit or limit participating doctors from charging their own prices to beneficiaries.

Unless Congress changes the statute, doctors who accept all Medicare patients must make do with the program's defined fee for covered services and cannot charge extra even if the cost of providing the services exceeds the amount that the practice is actually paid. Nonparticipating physicians that accept Medicare assignments on a case-by-case basis may balance bill patients, but the extra amount that can be charged is limited to a set percentage of the initial payment.

Physicians supporting a stronger legislative stance on the issue said that the ability to balance bill would alleviate many of the shortfalls that practices are facing, from inadequate Medicare funding to excess costs related to medical liability. They said that a federal solution would take the financial burden off physicians and predicted that private payers would follow the government's lead in relaxing the billing rules.