Recently, the Departments of Health and Human Services (HHS), Labor, and Treasury together announced a set of rules meant to eliminate surprise billing from commercial health plans. While this is a welcome change for patients, it does require additional due diligence from providers. Let’s talk about what to expect as we approach the activation of these rules in 2022.
What is the new rule?
On July 1, 2021, an interim final rule with comment period was issued by the Department of Health and Human Services (HHS), Treasury, and Labor entitled “Requirements Related to Surprise Billing; Part I.” This rule was drafted with the intention of protecting consumers from unexpected bills and excessive cost-sharing for health services, particularly related to out-of-network providers. Under this rule, patients are protected from receiving surprise medical bills for emergency services provided by out-of-network providers, as well as some non-emergency services provided by out-of-network providers at in-network facilities.
What does this mean for providers?
This rule dictates that out-of-network providers are not permitted to bill patients more than would be paid for in-network services in emergencies and certain non-emergency situations. This, obviously, can lead to reduced reimbursement. Additionally, providers must regularly submit updates to health plan directories so that information on which doctors are in-network is up-to-date and accurate. Also, it is the provider’s responsibility to be transparent regarding price should a patient choose to obtain a service from an out-of-network provider. That provider must provide a good faith estimate at least three days prior to the service and obtain patient consent to that price. Clearly, these are additional steps that providers will need to take to be in compliance and offset the effect of this rule.
What does this mean for patients?
For patients, this rule means less surprise bills. It means that when a patient visits the ER and receives and pays their facility bill, they won’t then be blindsided by a separate bill for the remaining balance of a provider who was out-of-network. It also means that patients will be able to choose an out-of-network provider for services if they wish, but that they will be able to do so with full knowledge of cost up front and the opportunity, should that cost be prohibitive, to find a suitable in-network replacement.
Surprise bills have been a big problem for patients as more health care cost responsibility has fallen on their shoulders in recent years. With this new rule, patients can rest assured that they won’t be hit with unexpected bills from out-of-network providers, particularly following emergency situations. Unfortunately, this does create the need for some additional due diligence on the part of providers as it relates to maintaining accurate records with insurance payers and providing up front cost estimations, although it’s nothing that providers can’t ease through awareness and proactive steps. Having the right software to support you is also important. MicroMD PM allows providers to check patient eligibility, helping providers to give up-front estimates where needed.
For more information or to get started, visit www.micromd.com or call 1-800-624-8832.
About the author,
Savanna Adams
Savanna is the Marketing Communication Specialist at Henry Schein MicroMD. She schedules emails to clients, prospects, and VARs, manages social media accounts, performs research, writes blogs and eBooks, and much more while helping to support the simple yet powerful MicroMD solutions.
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