The legal environment in Georgia is set for significant changes after the passage of SB 86 (Link). While there are many components of the bill, this article will focus primarily on the changes associated with how medical bills are presented and evaluated at trial. The new law changes Georgia’s longstanding collateral source rule, allowing evidence of both full bill charges and third-party payor rates (including Medicare) to enter the courtroom. For attorneys, this shift potentially changes the strategy of presenting medical damages in trial by showing why full bill charge comparison is the most accurate and reliable data point in third party liability cases. Below is a balanced look at the key changes, why they matter, and how Georgia medical billing experts can help navigate this new environment.
Historically, Georgia’s collateral source rule prevented juries from learning about third party payments such as health insurance reimbursement or Medicare coverage. Injured parties could present their full bill medical charges as evidence while any insurance discounts, adjustments or write-offs were shielded from the jury.
So what’s different now?
Under the new law, jurors can now see what a health insurer actually paid – or would pay – for a plaintiff’s care. The court will also admit evidence comparing the amount charged to the patient to third party negotiated rates even if the injured party did not have health insurance or did not use their health insurance. These data points will try to make the argument that the reasonable value of care is based upon what other medical providers are accepting as payment rather than what is usual, customary and reasonable from a charge perspective.
Attorneys on both sides must be data minded. Plaintiffs can still present the full bill, but defense counsel may highlight discounted rates which attempt to argue that the full bill charges are “inflated”.
Evidence about who paid (or who would pay) medical care was traditionally off limit to jurors. Given the passage of SB 68, that will no longer be the case. In cases in which health insurance was used, the amount that was paid and discounted will now be presented to the jury. Even in instances where the individual did not have insurance or went to a provider that was out of network, evidence of third party payor rates can still be presented. It’s well known that Medicare and Medicaid pay significantly lower rates than third party health insurance and full bill chargemaster rates. Many providers argue that Medicare barely covers the direct costs associated with providing medical care. These reimbursement rates are announced by the Centers for Medicare and Medicaid Services (CMS) and have not kept up with the pace of inflation (https://medicalcostexperts.com/the-rising-challenges-in-physician-and-ambulatory-surgical-center-reimbursements-2/).
Letters of Protection (LOP) allow patients to receive medical care when they cannot pay for the medical treatment up front. Whether it’s because the individual does not have health insurance or whether the individual doesn’t even have the funds to cover their deductible and/or co-pay. The new law requires more disclosure and transparency into the LOP arrangement.
Given the additional discovery on the provider side, the costs associated with treating third party liability patients will only increase.
Given these legal shifts, a Georgia medical billing expert witness is more crucial than ever. Firms like Abacus Analytics specialize in reviewing medical bills and medical records to determine if charges are usual, customary and reasonable. Abacus Analytics medical billing expert witnesses compare full bill charges against other full bill charges within a specific geographic region to determine if a provider’s charges are reasonable comparable to their peers. By utilizing multiple industry standard databases, Abacus Analytics can provide valuable insight and data points for presenting evidence of reasonable full bill charges.
Abacus Analytics’ medical billing expert witnesses are familiar with treatment under a letter of protection and can articulate the challenges for both providers and patients when they are seeking treatment for a third-party liability claim. They are experienced in presenting their findings through expert witness deposition and trial testimony.
Georgia’s recent tort reform, particularly in the changes to the collateral source rule, mark a new era of complexity in medical damages litigation. Whether you represent plaintiffs or defendants, successfully navigating these waters will require a deep understanding of various datapoints related to medical charges and medical reimbursement rates.
Working with a Georgia medical billing expert witness can help ensure that a data-driven valuation based on full bill charges can be presented at trial.
Abacus Analytics offers medical billing expert witness services for both plaintiffs and defendants. Our team specializes in evaluating medical bills, comparing billed amounts to customary rates, and explaining the nuances of third-party payor reimbursements. Contact us today to learn how we can help streamline your valuation strategy under Georgia’s evolving legal landscape.
Michael is an avid medical billing expert and team member of Abacus Analytics and focuses on stories and articles in and around the medical billing industry.
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