State Representative Jim Butler has emailed physicians across the state and requested that they respond to an electronic survey about price transparency. Rep. Butler is the author of the unworkable price transparency statute that has been temporarily enjoined from implementation by the Williams County Court of Common Pleas.
In May 2017, Rep. Butler proposed replacing the current law with this new proposal. The Ohio Hospital Association and the Ohio State Medical Association both rejected the offer. The reason given was that sending additional CPT codes for scheduled visits through a web portal not needed for prior authorization or pre-certification is an overwhelming administrative burden for practices. In addition, the appropriate CPT code for a visit can often not be determined in advance.
We urge family physicians to take Rep. Butler’s survey to explain concerns about administrative burdens in the primary care office or email comments directly to him.
Rep. Butler explains his proposed amendment to the existing statute as follows:
- The one piece of information that only providers have is the specific service or product the patient is scheduled to receive. Accordingly, within 24 hours of a patient making an appointment for services, the provider will send the CPT codes or product identifier for the scheduled services to the insurer. Providers will use exactly the same mechanism as is currently used for prior authorizations and pre-certifications (pursuant to another Ohio law, by January 2018, every insurer must have a web-based system for providers to transmit this information).
- CPT codes for Evaluation and Management appointments are exempt from the requirements and need not be sent to the insurer.
- Insurers have the rest of the information, such as patient contact, insurance plan details, and deductible status. Upon receiving the CPT or product code from a provider, starting in 2019, the insurer will immediately send the patient a price estimate electronically via an app or email. The patient may request that a paper copy be mailed to them by the insurer if the appointment is more than two days out.
- A provider may voluntarily provide the estimate directly to the patient.
- If the patient requests, the provider will also give the patient the CPT code or product identifier for the scheduled service.
- Insurers must maintain websites for patients to use CPT codes or product identifiers to shop for services within the provider’s network.
Rep. Butler asks for physician feedback on his new bill. Take Rep. Butler’s survey or email comments directly to him.