AMA meeting: AMA to renew fight for Medicare balance billing

Some physicians say patients understand that they are struggling with practice costs and would accept balance billing.

By Damon Adams, AMNews staff. Dec. 3, 2007.

Honolulu -- Frustrated by Medicare pay cuts, representatives to the AMA House of Delegates directed the American Medical Association to call for national legislation to allow physicians to bill patients for costs Medicare doesn't cover.

At its Interim Meeting last month, the house adopted policy directing the AMA to devote its political and financial resources to initiate a measure at the appropriate time that would allow Medicare balance billing. The policy calls for introducing legislation that would end budget-neutral restrictions inherent in a Medicare physician payment structure that interferes with patient access.

In addition, delegates want the proposal to preempt state laws prohibiting balance billing and forbid inappropriate inclusion of bans on such billing in private physician-insurer contracts. The AMA would develop model language for doctors to use in insurance contracts that try to restrict balance billing of any insured patient.

With no permanent fix for Medicare cuts in sight, doctors said it makes sense to pursue a law that lets them bill Medicare patients the difference between reimbursement rates and what it costs to treat patients.

"What you see is a symptom of how difficult it is to maintain practices. It's physicians frustrated with reduced income," said AMA Trustee Rebecca J. Patchin, MD.

The action comes as doctors continue to fight an average 10.1% Medicare physician payment cut set to take effect Jan. 1, 2008. Doctors vowed to keep pressing for a solution to the Medicare pay formula, but they said balance billing is needed to offset pay cuts.