California Answers Question Over How Doctors Are Compensated If Law Protects Patients From Surprise Bills
The new payment system, finalized on Jan. 1, is based on commercial rates paid by health insurers for similar medical services in the same geographic area, adjusted for inflation.
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New Payment Model Tackles ‘Surprise Medical Bill’ Issue
Under AB 72, plans must either pay providers 125 percent of the Medicare rate or an “average contracted rate”, which the state was required to set by Jan. 1, 2019. Before the adoption of the new system, plans had been using an interim rate. The new payment system is based on commercial rates paid by health insurers for similar medical services in the same geographic area, adjusted for inflation. (Caiola, 1/3)