Final Rule Implements Ban on Surprise Medical Billing
On Aug. 19, 2022, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) jointly released a final rule implementing the ban on surprise medical billing under the No Surprises Act (NSA), which was enacted as part of the Consolidated Appropriations Act, 2021 (CAA).
This rule finalizes two interim final rules released in July 2021 and September 2021, with certain changes related to the independent dispute resolution (IDR) process that has been the subject of ongoing litigation.
The Departments also released FAQs on NSA implementation in conjunction with the final rule that provide more detail on the surprise medical billing ban.
Surprise Medical Bills
Surprise medical bills occur when patients unexpectedly receive care from out-of-network providers (for example, treatment at an in-network hospital involving an out-of-network doctor). Patients often cannot determine the network status of providers during treatment to avoid additional charges and, in many cases, are not involved in the choice of provider at all.
Overview of the Final Rules
The final rule is generally intended to make certain medical claims payment processes more transparent and clarify the process for providers and health insurers to resolve their disputes. It:
- Implements certain disclosure requirements related to information that group health plans and health insurance issuers offering group or individual health coverage must share about the qualifying payment amount (QPA) (generally, the health plan’s median contract rate for the item or service in the geographic area);
- Finalizes certain changes related to the federal IDR process in light of ongoing litigation; and
- Requires plans and issuers to disclose additional information in situations where they change a provider’s billing code to one of lesser value (lowering the payment to the provider).
For more information on employee benefits, contact INSURICA today.
About the Author
Share This Story
Responsible Chemical Storage, MSDS and Spill Preparedness
At INSURICA, we recognize the significant concern that managing chemical-related risks poses for environmental businesses. To ensure a safer work environment, it is crucial to prioritize proper chemical storage, understanding Material Safety Data Sheets (MSDS), and being prepared for potential spills. These elements are essential facets of effective risk management.
Creating a Cybersecurity Culture
Employees are an organization’s first line of defense against cybercriminals. For this reason, they are also commonly targeted. In fact, the vast majority (88%) of data breaches are caused by employee mistakes, according to Stanford University. Unfortunately for organizations, a single mistake can result in costly losses, reputational damage and lost or stolen data.
Healthcare Industry Trends to Watch
The healthcare industry plays a vital role in the U.S. economy, providing medical services and coordinating care for patients. It is an industry that constantly evolves, facing challenges and trends that require attention and adaptation. In this article, we will explore some of the key trends in the healthcare industry and their potential implications.