Surprise medical bills

No Surprises Act Implementation Yields Mixed Results

Is the No Surprises Act working? Is it protecting patients from surprise medical bills? Are providers and insurers happy? The Washington Post reports mixed results. On one hand, millions of people have been protected from surprise medical bills. But on the other hand… Experts thought that once the terms of the program were understood there would be only about 22,000 cases sent to arbitration – the law’s Independent Dispute Resolution process – in 2022. Instead, nearly 500,000 cases went that route, with nearly half of the requests for arbitration coming from physician staffing companies owned by private equity firms. At [...]

joe2024-02-14T16:33:47+00:00February 14, 2024|Uncategorized|

Federal Health Policy Update for November 2

The following is the latest health policy news from the federal government for October 27 – November 2. Some of the language used below is taken directly from government documents. 340B Remedy Payments Late Thursday afternoon CMS published its final Medicare remedy for underpayments for 340B prescription drugs that was implemented in 2018 but rejected by the Supreme Court last year. According to the regulation, 340B remedy payments to hospitals will be made after this rule takes effect, which is 60 days after it is officially published in the Federal Register; publication is scheduled for November 16. The final regulation [...]

admin2023-11-02T18:01:15+00:00November 2, 2023|340b, Centers for Medicare & Medicaid Services, COVID-19, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare reimbursement policy|

Federal Health Policy Update for August 31

The following is the latest health policy news from the federal government for August 25-31. Some of the language used below is taken directly from government documents. No Surprises Act For the second time in less than a month a court has rejected how federal agencies are implementing the Independent Dispute Resolution process of the No Surprises Act. A federal court concluded that the process for establishing the Qualifying Payment Amount, or QPA – the median rate insurers pay for in-network services and a critical factor in settling payment disputes – inappropriately permits insurers to depress that rate and unfairly [...]

admin2023-08-31T16:09:59+00:00August 31, 2023|Centers for Medicare & Medicaid Services, Medicaid, Medicare, MedPAC|

Federal Health Policy Update for August 10

The following is the latest health policy news from the federal government for August 4-10. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has temporarily suspended the federal Independent Dispute Resolution process, which adjudicates problems involving surprise medical bills, in the wake of a federal court ruling that found some of the process’s underlying regulations invalid. CMS has directed the certified Independent Dispute Resolution entities to pause all dispute resolution activities. As a result, providers and insurers temporarily cannot initiate new disputes. Learn more from this CMS notice. CMS [...]

admin2023-08-10T16:32:27+00:00August 10, 2023|Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|

No Surprises Act Arbitration Decisions Resume

After revising its guidelines on how certain medical fee disputes should be resolved, the Centers for Medicare & Medicaid Services has directed the Independent Dispute Resolution entities responsible for arbitrating fee disputes between payers and providers to resume making and issuing their decisions. After a February ruling in federal court that aspects of CMS’s implementation of the 2020 No Surprises Act contradicted the language of the act itself and unfairly favored payers over providers, CMS ordered a moratorium on new arbitration decisions for disputes filed on or after October 25, 2022 while it reviewed and revised its guidance on how [...]

admin2023-03-22T13:00:58+00:00March 22, 2023|Uncategorized|

Feds Pursue Next Regs for Surprise Billing Law

In their continuing effort to implement the complex No Surprises Act, the 2020 law that seeks to prevent consumers from receiving surprise medical bills, federal regulators are now turning their attention to how providers and payers should inform insured individuals about the costs they may incur for procedures and purchases. Specifically, the federal agencies with jurisdiction over the law and its implementation – the Department of Health and Human Services, the federal Office of Personnel Management, the Internal Revenue Service, the Department of the Treasury, the Department of Labor, and the Employee Benefits Security Administration – have issued a request [...]

admin2022-09-22T13:00:58+00:00September 22, 2022|Uncategorized|

Surprise Bill Law’s “Good-Faith Estimate” to Challenge Providers

The requirement to give patients “good-faith estimates” of the costs associated with planned medical procedures will pose one of the biggest challenges to providers seeking to meet the implementation requirements of the 2020 No Surprises Act, which was intended to protect consumers from surprise medical bills, especially from providers not in their health insurers’ provider networks. Under the law’s implementing regulations, providers are often responsible for delivering good-faith estimates to their patients within 24 hours of scheduling a procedure. Eventually, the “convening provider” also will need to anticipate patients’ potential costs beyond the procedure itself and collect estimates for those [...]

admin2022-04-11T06:00:59+00:00April 11, 2022|hospitals|

Federal Health Policy Update for Tuesday, November 23

The following is the latest health policy news from the federal government as of 2:30 p.m. on Tuesday, November 23. Some of the language used below is taken directly from government documents. The White House The White House has posted a transcript of the November 22 press briefing given by its COVID-19 response team and public officials. Go here for the slides presented during that meeting. Provider Relief Fund HHS announced that it has begun distributing $7.5 billion in American Rescue Plan rural payments to providers and suppliers that serve rural Medicaid, Children's Health Insurance Program (CHIP), and Medicare beneficiaries. [...]

admin2021-11-23T17:27:12+00:00November 23, 2021|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Coronavirus, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, Telehealth|

Surprise Billing Ban: Now the Hard Part Begins

Congress’s passage of a ban on surprise medical bills came after years of debate on the issue and was still somewhat of a surprise. But in hindsight, passing the ban may end up being the easy part. Now, federal officials need to develop regulations that will flesh out the ban, define terms, establish new processes, and more, and every indication is that this will be no less difficult than developing and passing legislation. According to Politico, lobbying on future regulations has already begun, with providers, consumer advocates, insurers, and even private equity interests vying to ensure that their needs are [...]

admin2021-05-03T06:00:45+00:00May 3, 2021|Uncategorized|

A Look at Surprise Medical Bill Legislation

While Congress’s decision this week to put off addressing the surprise medical bill challenge until next year has disappointed many, that decision did not reflect any lack of ideas for what to do. At last count, various parts of Congress were considering four major surprise medical bill proposals: one from the Senate Health, Education, Labor and Pensions Committee, one from the House Energy and Commerce Committee, one from the House Ways and Means Committee, and a compromise proposal from the Senate HELP and House Energy and Commerce committees. Some have been around for some time while one emerged only in [...]

admin2019-12-18T06:00:37+00:00December 18, 2019|Congress|