The Departments of Health and Human Services, Labor, and Treasury have issued an Interim Final Rule as part of a law passed under former President Donald Trump that will limit “surprise” medical bills assessed to patients who are unknowingly treated by doctors and facilities that are outside of the patients’ healthcare networks. The issuance of the rule, which is scheduled to go into effect on Jan. 1, 2022, is the first step toward the enactment of the “No Surprises Act” which Congress passed last year.
The IFR — all 411 pages of it — is available by clicking here.
About 20% of individuals who visit emergency rooms are likely to receive surprise medical bills, because they are either sometimes treated by doctors who are not part of the hospital’s insurance network or because the patient was taken to a facility that is not part of his or her health plan. Under the “No Surprises Act”, patients will only be responsible for the in-network cost-sharing responsibilities, such as deductibles and co-pays, while insurance companies and healthcare providers would negotiate the remaining unpaid portions of a patient’s bill.
Surprise billing is important to the accounts receivable management industry because one-in-10 surprise medical bills are for at least $400, a financial threshold that many consumers find too much to be able to afford, according to studies and reports.
“No patient should forgo care for fear of surprise billing,” said HHS Secretary Xavier Becerra, in a statement. “Health insurance should offer patients peace of mind that they won’t be saddled with unexpected costs. The Biden-Harris Administration remains committed to ensuring transparency and affordable care, and with this rule, Americans will get the assurance of no surprises.”
The IFR is the first of several requirements of the federal government to implement the “No Surprises Act.” Because it is a rule, it will be subjected to a 60-day comment period, which will begin once it is published in The Federal Register. Among the provisions of the IFR are:
- 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.
