Page 29 - Layout 1

LEGAL EASE

positive of what a reasonable charge is, at the very least they are rel- billing practices among the patient base.
evant to the ultimate determination of what is a fair charge. It’s important to realize that a discounted rate doesn’t necessarily
mean that’s the highest rate a provider can reasonably charge. The
Bottom line: The Court required the hospital to disclose to Crys- Court recognized there may be legitimate reasons to justify a dis-
tal’s attorney their pricing structure for discounted, negotiated rates counted rate which don’t apply to an uninsured patient. But, at the
with insurers of all types. very least, the patient (and, ultimately a jury if the provider and pa-
tient can’t agree) is entitled to know of any difference in rates
What’s this mean? For starters, it means that the glass ceiling of se- charged by the provider to different classes of patients.
cret, allegedly proprietary fee schedules is cracking. More transparency Perhaps the most significant aspect of this decision is that the
in medical billing has now been legally mandated. The implications shroud of secrecy surrounding tiered-billing practices appears to
of this decision go well beyond hospitals and the liens they may file have come to an end. Not only may this benefit uninsured patients
in personal injury lawsuits by which they seek to recover their bills. who arguably were being overcharged, but it may benefit other
The Court’s holding is much broader than that. It strongly implies providers, like yourself, who may discover their contract rates aren’t
that any healthcare provider seeking recovery for any service under as favorable as a competitor’s contract rate. This may portend a
any circumstance will have to provide full information on its billing move towards a day when rates are more standardized. Like buying
practices if there is any difference whatsoever in how the provider a loaf of bread at the grocery store where the price doesn’t change
bills patients. It can now be argued that doing a routine EKG or lab depending on whether the purchaser is hungry, wealthy, or reim-
work in your private medical office should be billed at the comparable bursed for the cost. Maybe the same will be said of that routine of-
rates whether the patient is uninsured or fully insured. Providers can fice EKG. The day may not be far off when everybody will know
only recover for “reasonable” charges and, to determine what is rea- what everybody charges and pays for medical services. Hard to say.
sonable, the law now requires the provider identify any differences in The full implications of this decision are just now rolling out.

THANK YOU

to the large group practices with
100% MEMBERSHIP in BCMS and TMA

ABCD Pediatrics, PA Renal Associates of San Antonio, PA
Clinical Pathology Associates San Antonio Eye Center, PA
Dermatology Associates of San Antonio, PA San Antonio Gastroenterology Associates, PA

Diabetes & Glandular Disease Clinic, PA San Antonio Infectious Diseases Consultants
ENT Clinics of San Antonio, PA San Antonio Kidney Disease Center
Gastroenterology Consultants of San Antonio San Antonio Pediatric Surgery Associates, PA
General Surgical Associates Sound Physicians
Greater San Antonio Emergency Physicians, PA South Alamo Medical Group
Institute for Women's Health South Texas Radiology Group, PA
Lone Star OB-GYN Associates, PA Tejas Anesthesia, PA
M & S Radiology Associates, PA The San Antonio Orthopaedic Group
MacGregor Medical Center San Antonio Urology San Antonio, PA

MEDNAX WellMed Medical Management Inc.
Peripheral Vascular Associates, PA

Contact BCMS today to join the 100% Membership Program! *100% member practice participation as of May 22, 2018.

visit us at www.bcms.org 29