If you’ve been paying attention to what’s going on with healthcare in Florida, you probably know that the Florida House passed a bill that gives physicians the option to opt out of services for reasons of conscience – meaning they won’t face negative repercussions for refusing to perform a medical procedure. But payers are mentioned in the bill too, and this isn’t getting enough attention.
If you read the text of the bill, payers are mentioned right alongside providers. For example, look at this wording [1]:
“A health care provider or healthcare payor has the right to opt out of participation in or payment for any health care service on the basis of a conscience-based objection.”
So, payers are allowed to withhold payment for services based on “Conscience-based objection”. According to the bill, this is defined as,
“…an objection based on a sincerely held religious, moral, or ethical belief. Conscience, with respect to entities, is determined by reference to the entities’ governing documents; any published ethical, moral, or religious guidelines or directives; mission statements; constitutions; articles of incorporation; bylaws; policies; or regulations.”
This definition offers a lot of leeway.
So, what does this mean? I don’t think it’s cause for alarm, but I do think providers who could be affected should keep a close eye from a physician billing services perspective, specifically around denials and during contract negotiations. This is because the bill opens a potential new path for denials and payers not properly compensating providers – and providers would be left with few options if they’re in a state that takes similar measures.
I want to be clear that I don’t see this as a blank check for payers to deny claims however they like. But I do think that it could mean providers in multiple states around the country might need to shift their thinking around denials management and physician billing services.
Now is as good a time as ever to refresh your denials management strategy and approach to physician billing services with coming changes in mind. And if your state doesn’t have comparable legislation in play, you’ll want to watch the political news in your area to see if something similar, even if less aggressive, might be headed your way.
References
[1] Florida House of Representatives, “CS/CS/HB 1403: Protections of Medical Conscience,” 2023. Available: https://www.flsenate.gov/Session/Bill/2023/1403/BillText/c2/PDF.
Hemant Apte, Chief Executive Officer in
