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STATE | ASPS and the Ivy Society Comment on Out-of-Network Bill

As seen in a multitude of other states throughout 2017, out-of-network billing legislation advanced in Pennsylvania at the end of the year. These bills seek to ban balance billing and institute an independent dispute resolution process to resolve billing disagreements. The measures also define the usual and customary rate (UCR), which will be used as the basis for out-of-network reimbursement. UCR is defined by the bill sponsors as the 75th percentile of amounts for the healthcare service performed by a provider who is in the same or similar specialty and who provides services in the same geographic area, as reported in a benchmarking database. However, the Senate version pegs the UCR to the 75th percentile of all allowed amounts, while the House bill ties the fee schedule to the 75th percentile of all charged amounts.

While Senate bill has not been heard in committee, the House bill passed its respective committee and is currently eligible for a floor vote in the full House, where it is expected to be voted on in the coming weeks. ASPS and the Ivy Society submitted co-signed comments to the House urging for amendments to the bill prior to a floor vote.

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