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Government issues final rule to prevent unexpected medical bills


accident bills, medical bills,

People continue to get ‘unexpected medical bills’ without knowing it Providers outside of their health insurance network, even after Congress passed a law prohibiting it.

On Friday, the Labor, Treasury and Health and Human Services departments took steps that are expected to completely prevent consumers from receiving them.it Published final rule on standards for arbitration procedures between suppliers and payers, key to implementing the standard no surprise bill.

“This final rule Will make certain medical claims payment processes more transparent to providers and clarify the process by which providers and health insurers resolve disputes,” the Department of Labor said in a release.

These rules apply to group health plans and health insurance issuers that offer group or individual health coverage.

“These final rules require increased transparency that will help suppliers, facilities and air ambulance providers to engage in more meaningful public negotiations with programs and issuers, and will help inform their submissions to accredited independent entities offer to resolve the claims dispute,” the U.S. Department of Labor said.

The final rule is an updated version of the July and October 2021 interim rules and takes into account federal court challenge from Texas Medical Association and air ambulance suppliers Life Net Inc. In both cases, the judge ruled Part of the arbitration process outlined in the contingency billing rule violates the Administrative Procedure Act, which requires a public comment period when the government issues a new award.

In response to a MedCity News inquiry about the recently finalized rules, the TMA said: “We are reviewing the rules and considering next steps.”

government finalized The arbitration process is called an independent dispute resolution process or federal IDR process to determine the total payment amount for out-of-network health care services for which the Act prohibits unexpected billing. The final rule also includes guidance on how accredited IDR entities make payment decisions, and instructs these entities to provide additional information and rationale in their written decisions.

E.g, If an insurer “downgrades” or changes a billing code to reduce the provider’s compensation for services, the insurer must issue a statement that the billing code has changed and explain the reasons for the change.

In November, the departments Issue interim rules Related to prescription drugs and health care spending. The rule requires group health plans and issuers to submit information about the most and most expensive drugs dispensed and information about premiums, including the average monthly premiums paid by employers and employees.

According to the Centers for Medicare and Medicaid Services, “Together, these provide the foundation for protecting consumers from unexpected bills.”

Photo: KLH49, Getty Images



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