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.
Medicare 10% Reduction in Reimbursement for Anesthesia has been reduced to 3%, effective 01/01/2021
The approximate 10 percent reduction in the anesthesia conversion factor (CF) scheduled to take effect on Jan 1, 2021 has been modified. A statement published by the American Society of Anesthesiologists (ASA) provided the following take on the CAA:
The scheduled cut to the anesthesia conversion factor will be reduced to a 3% cut rather than the previously proposed 10% cut. An improvement, but still entirely inadequate for a specialty already hampered with a flawed payment rate, whose members are caring for COVID-19 patients on the frontlines of the pandemic.
According to an update released by the Centers for Medicare and Medicaid Services (CMS), the new national anesthesia CF will officially be 21.5600 for 2021 instead of the originally set anesthesia CF of 20.0547. This translates to a 2.9 percent reduction from the 2020 anesthesia CF, which is far better than the 9.7 percent reduction that was authorized in the 2021 Medicare Physician Fee Schedule (PFS) Final Rule. Your exact anesthesia CF will vary depending on your geographic location. You can search for the CF in your area by going to the following CMS link: Anesthesiologists Center | CMS.
