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Legislative update regarding billing members of a PPO or EPO

Thursday, May 26, 2016   (0 Comments)
Posted by: DCMS
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Legislative Update from the Florida Board of Medicine:

Important Legislative Update Regarding Billing Members of a PPO or EPO:

Not knowing the requirements or grounds for discipline within your profession does not alleviate you from accountability of practicing your profession responsibly. Therefore, please read the information below carefully as it pertains to your professional responsibilities.

Health Care Services

Effective Date: July 1, 2016

Governor Scott signed HB 221 into law on Thursday, April 14, 2016.  It relates to billing and includes these changes to the law: 

  • Prohibits health care providers from balance billing members of a PPO or EPO for emergency services, or for non-emergency services when the non-emergency services are provided in a network hospital and the patient had no ability or opportunity to choose a network provider.
  • Consumers who have PPO or EPO coverage would only be responsible for billing differences in circumstances where they knowingly opted to receive out-of-network care.
  • Hospitals are exempt from the balance billing prohibition.

Participating and non-participating providers are defined in section 627.419 and section 627.6471, Florida Statutes.

Protections for members of HMO's would remain unchanged.

The bill also adds new grounds for disciplinary action by the Board and the Department:

  • Section. 456.072(1)(oo) - Willfully failing to comply with s. 627.64194 or s. 641.513, Florida Statutes.  Chapter 456, Florida Statutes are general laws related to all health care practitioners. 
  • Section. 458.331(1)(tt) - Willfully failing to comply with s. 627.64194 or s. 641.513, Florida Statutes.  Chapter 458 is the medical practice act.

The Board of Medicine will be creating penalty ranges for the grounds for disciplinary action listed above at their June 2, 2016 Rules/Legislative Committee Meeting. The meeting is being held at the Embassy Suites Ft. Lauderdale, 1100 SE 17th Street Causeway, Ft. Lauderdale, FL. See the Board of Medicine's website at www.FLBoardofMedicine.gov for more information regarding the meeting. 

To read the entire bill, click here.