What You Should Know About Surprise Medical Bill News

What You Should Know About Surprise Medical Bill News

Krisette Capati

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Consumer groups have been pushing for more stringent laws against surprise medical bill news, which can occur when an out-of-network provider treats the patient without their knowledge or consent. The new regulation defines a surprise bill as any situation where the medical bills sent to the patient exceed the amount they owe if they had received care from in-network providers.

Congressional leaders have studied various policy solutions to prevent patients from these surprise bills for the past two years. In February 2020, Congress outlined the policy options to address medical surprise bills at the federal level. The American College of Surgeons (ACS) wanted to fix the problem with a comprehensive solution to eliminate patients in the middle of negotiations between providers and insurers. The advocacy requires equal coordinated efforts from doctors, hospitals, and healthcare insurers.

The ACS has consistently worked for surprise medical billing reform that would benefit patients, improve insurance plan transparency and accountability, and address limited and insufficient networks throughout the process.

Table of Contents

Updates on Surprise Medical Bill News

What You Should Know About Surprise Medical Bill News

Recently, the American Medical Association (AMA) and the American Hospital Association (AHA) sued the Biden administration over the surprise medical bill regulations.

The lawsuit exposes the lobbying battle that’s now playing out among health care industry participants over a significant reform to the medical system meant to protect patients from receiving unexpected medical expenses.

Biden’s administration issued the rules in response to a bipartisan bill passed in December 2020 to prevent patients from incurring surprise medical expenses when they visit the emergency department or receive other health treatments if one of the doctors treating them is outside their insurance network.

Healthcare professionals and insurers say they support the protection of patients from these surprise medical bills. However, the situation escalated for months between physicians and hospitals, and on the other side, the insurers and patient groups. The issue was how much insurers would pay the doctors once the patient was out of the scene.

The lawsuit argues that the administration’s regulations are not what was agreed to by the people who wrote the law. Doctors and hospitals are also worried because they think this will lead to cuts to how much they can get paid, which will also affect the quality of care to patients.

Surprise Medical Bill News on January 1, 2022

Unless a court takes the necessary steps or the current administration modifies the regulations to stave off health care provider pressure, the stricter standards will become active on January 1, 2022.

Doctors and hospitals are not happy with the new law because of its arbitration process that determines how much the physicians should receive from insurers.

Healthcare practitioners and hospitals disagree with one part of this law. The arbiter should start by assuming that the correct amount that they should receive is what is usually paid for that service in that geographical area. The doctors also argue that the weight of training they had should be considered.

How the Medical Bill News Will Affect Hospital Billing Processes in 2022

What You Should Know About Surprise Medical Bill News

Balance billing is when a healthcare provider bills the patient for the difference between what they charge and what insurance will pay. This can happen in cases where an out-of-network doctor or specialist treats the patient or when an insurance company doesn’t fully cover charges by an in-network provider. Balance billing has become increasingly common as deductibles rise.

In the new federal rule, balance billing is applicable for post-emergency care and non-emergency services if specific criteria are met. Even if balance billing is allowed in certain situations, hospitals will have to do things differently. For example, they will need to give people notice and get their consent unless the hospital is in a state where these laws already exist.

Generally, when state and federal regulations conflict, the stricter one takes precedence. So if a state prohibits balance billing and a new federal rule allows it without getting patient consent, the new federal law would take precedence.

The Surprise Medical Bill News: “No Surprises Act” What You Should Know

On January 1, 2022, the No Surprises Act will take effect. Here are the things you should know:

  • Balance billing will no longer be allowed for emergency care from out-of-network providers. Suppose a patient gets emergency care at an out-of-network facility or from an out-of-network doctor at an in-network facility. In that case, the patient will not pay the additional and must instead be settled between the doctor and health plan.
  • If you go to the doctor, your insurance company will pay for it. It is based on how much they would have paid if you went to an in-network doctor in their plan.
  • This law says that providers have to take the in-network rate and not charge more than their deductible, co-pay, or co-insurance.
  • If there is an argument over the rates, the person who pays can send a “good faith” payment within 30 days. Then if not accepted by the provider, the patient can negotiate and resolve the dispute.
  • Certain healthcare providers and facilities have to publish a notice on a public website about the new regulation.

No Suprise Act and HIPAA-Compliance of Healthcare Providers

What You Should Know About Surprise Medical Bill News

One of the goals of the legislation is to protect patients from increased financial hardships stemming from surprise medical bills. This goal will be accomplished by holding healthcare providers financially accountable for surprise medical bills. The legislation does not specify how providers should be penalized, but it is likely that enforcement will involve HIPAA compliance.

Under HIPAA, healthcare providers are required to disclose any potential billing surprises prior to providing services. Failure to do so can result in significant fines. In addition, under HIPAA’s Breach Notification Rule, providers are required to notify patients of a data breach within 60 days of discovering it. Healthcare providers that fail to comply with either of these regulations could face significant penalties from HHS.

It is unclear how the No Surprise Act will impact HIPAA compliance, but it is likely that enforcement will become more strict. Healthcare providers should take steps to ensure that they are in compliance with HIPAA and the new federal law to avoid penalties. 

One way to do this is to review your organization’s billing procedures and make sure that patients are always notified of any potential billing surprises prior to providing services. You should also consider implementing a data breach response plan in case of an incident.

The hospital billing software can also help manage all billings in one place, and they are fully HIPAA-compliant. 

Final Thoughts

The new federal rule is a piece of legislation that will come into effect in 2022. You may have heard about it on the news or seen it pop up all over social media, but what does this really mean for you? This blog post has given you an overview of how this bill could affect your hospital billing process and compliance with HIPAA regulations.

If you want to make sure that you’re always following HIPAA regulations, you may also check our HIPAA-compliant mobile faxing app that doctors and healthcare professionals use when sending and receiving fax online.

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