HHS Announces Surprise Medical Billing Rule

Today, the Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and non-emergency care. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans.

Among other provisions, today’s interim final rule:

  • Bans surprise billing for emergency services. Emergency services, regardless of where they are provided, must be treated on an in-network basis without requirements for prior authorization.
  • Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates.
  • Bans out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances.
  • Bans other out-of-network charges without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.

The regulations issued today will take effect for health care providers and facilities January 1, 2022. For group health plans, health insurance issuers, and FEHB Program carriers, the provisions will take effect for plan, policy, or contract years beginning on or after January 1, 2022.

Fact sheets on this interim final rule can be found here and here.

The interim final rule with comment period can be accessed here.

9.6% in 2020 Anesthesia Reimbursement from Medicare

With the publication of the 2021 PFS Final Rule on December 1, the nation’s anesthesiologists and anesthetists were left in dismay, if not disbelief, having been dealt a significant financial setback.  The national anesthesia CF for 2021 has been set at 20.0547, down from the 2020 CF of 22.2016.  This represents a 9.6 percent decrease in potential anesthesia revenue—from a conversion factor perspective.  The exact anesthesia CF will vary based on your practice location.  To determine the anesthesia CF in your area, you can visit the following link: https://www.cms.gov/Center/Provider-Type/Anesthesiologists-Center.

This is the second year in a row that Medicare has reduced the reimbursement to the Anesthesia specialty.