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HomeHealthcareFederal agencies issue rules to enforce accidental billing ban

Federal agencies issue rules to enforce accidental billing ban

The Ministry of Health and Human Services, together with the other two agencies, Issued the first set of regulations Implement No accident,this is Enacted as law At the end of 2020.

This Provisional final rule The announcement on Thursday will restrict accidental billing — that is, when patients are charged for out-of-network care, which is usually unexpected — for Americans who are insured through employer-sponsored and commercial health plans. Promulgated by HHS, the Ministry of Labor, the Ministry of Finance, and the Office of Personnel Management, it will take effect on January 1, 2022.

This rule prohibits:

  • Surprise bill for emergency services.
  • High off-network cost sharing for emergency and non-emergency services.
  • In any case, the out-of-network cost of supplementary care for facilities in the network.
  • Other out-of-network fees will not be notified otherwise.

HHS Minister Xavier Becerra said in a press release: “No patient should give up care for fear of unexpected charges.” “Health insurance should give patients peace of mind that they will not be burdened with unexpected costs.”

Under the new rules, the supplier’s out-of-network rate (including any cost sharing) will be determined by the applicable full payer model agreement or state law. If there is no applicable agreement or specific state law, the provider will receive the amount agreed upon by the payer and the provider or third-party arbitrator.

The “No Accident Law” provides for a negotiation period during which providers and payers can resolve out-of-network claims. However, if they are unable to reach an agreement, they will enter a binding arbitration procedure and an independent arbitrator will help make the final payment decision.

The newly promulgated rules do not include any provisions regarding arbitration entities or arbitration procedures.According to reports, these will be released “soon” Fact sheet Provided by the Center for Medicare and Medicaid Services.

The rule has not yet been finalized, and the agency that issued the rule is seeking comments within 60 days of its publication in the Federal Register.

Unexpected health care bills are a major concern of the American public.About two thirds Say they are worried A 2020 report by the Caesars Family Foundation shows that it can cover unexpected medical expenses.And this concern is not unfounded-66.5% of bankruptcies are Linked to medical expenses.

Containing unexpected medical expenses is also one of the few real bipartisan issues in the healthcare sector, most Democrats and Republicans Support government action To protect patients from these costs.

The industry has less support.An early version of the “No Accident Law” released in December last year drew criticism from both sides provider with Payer organization.

Photo: KLH49, Getty Images

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