Billing Entity Choice bill S6123 (Rivera)/A5750 (Paulin)
In response to numerous questions and misinformation circulating in the industry, we want to clarify what the Billing Entity Choice bill S6123 (Rivera)/A5750 (Paulin) does and doesn’t do. Our goal is to give you the facts.
Myth #1: This bill targets a specific aggregator, billing entity, or insurance plan.
Fact: Insurance plans have mandated that agencies use a third-party aggregator whose software isn’t compatible with the agency’s chosen EMR or billing vendor. Those using a single vendor may not have experienced delays, but others are facing massive accounts receivable issues due to software incompatibilities.
Myth #2: Licensed Home Care Services Agencies (LHCSA) or Fiscal Intermediaries (FI) will have to change billing vendors or EVV aggregators.
Fact: The bill restores your freedom to choose a billing vendor that best meets your needs. Your business will not be disrupted if you are happy with your vendor and are not experiencing payment issues.
Myth #3: The bill eliminates certain EVV aggregators or billing vendors.
Fact: There is NOTHING in the bill that eliminates EVV aggregators or billing vendors. It simply requires managed care plans to allow providers to select their preferred system for submitting bills. Plans may request EVV through their chosen aggregator, but the power to choose will be yours.
Myth #4: It puts providers or plans out of compliance with the CURES Act.
Fact: The bill maintains the status quo regarding EVV submissions, ensuring compliance with the federal 21st Century CURES Act.
Why does home care need this bill right now?
Providers have significant unpaid claims going back to 2021, causing cash flow problems and forcing additional resources to address these challenges.
Reports from providers:
- We were required to use a plan-mandated aggregator, leading to numerous billing issues and significant financial losses.
- Our organization has lost high six to low seven figures due to billing issues, not including the human resources needed to resolve them.
- We have ongoing Accounts Receivable collection issues in the multi-millions due to using the plan-required aggregator.
What you can do right now:
- Think hard before opposing the bill: Some businesses have sent letters in opposition under pressure, only to rescind them later. HCP believes providers should make business decisions based on their own needs and preferences.
- Read the bill: The text is straightforward and restores your freedom to choose a billing vendor.
- Take Action: Legislators need to hear that you value your right to choose. Click here to send your message.
- Stop the disinformation: Share this post with colleagues who may have been misinformed about the bill. Let’s stop the rumors and fearmongering together.
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