HHS Proposes More Compliance Rules Aimed at Curbing Surprise Medical Bills

Compliance Rules

The healthcare consumers finally breathe a sigh of relief. After the U.S. Department of Health and Human Services (HHS) announced the much anticipated No Surprise Act. The basic purpose of this act is to protect the patients from surprising medical bills. And enable patients to receive medical aid in an emergency even from the out of network providers_without the fear of unaffordable copayments, out of the pocket costs and high deductibles.

Moreover, in order to ensure the real-time implementation of this rule. The federal authorities have recently imposed civil monetary penalties of up to $10,000 on providers and healthcare facilities. Who fails to comply with this federal act. Furthermore, to ensure the price transparency in the air ambulance costs and save the patients from high unexpected medical bills. The HHS, Labor, and the Treasury (collectively, the Departments), along with the Office of Personnel Management (OPM), has unveiled the proposed rule. That promotes transparency in Air Ambulance costs, agents and broker compensation.

According to details, the air ambulance services providers and issuers are bound to submit the complete and accurate data _describing air ambulance services specified in the reporting requirements of the No Surprises Act. As per the rule, the federal agency, the Centers for Medicare & Medicaid Services (CMS) is responsible to ensure the complete enforcement of Title I (the No Surprises Act) and Title II (Transparency) of Division BB of the Consolidated Appropriations Act of 2021. Particularly in the states that have failed to enforce the key provisions of the No Surprise Act. Or don’t have authority to enforce these rules. Additionally, CMS is asked to inform the healthcare consumers about compensations being paid to agents and brokers_who help them select health insurance. This is the latest regulatory action in a series of rulemaking implementing the No Surprises Act.

Moreover, the rule has clearly given instructions and unveiled the process. That CMS will play its active role in enforcing new surprise billing and other consumer protections. Moreover, the newly proposed rule will give the CMS full authority to take action against the healthcare providers or medical practices that fail to implement the rule. It would ensure consumer protection from surprise bills as well as financial uncertainties, caused by unexpected invoices.

Health and Human Services Secretary Xavier Becerra in an official statement has said that the air ambulance industry is a highly consolidated market. And patients more often receive surprise medical bills, when they get the services of an air ambulance. While shedding light on the Biden-Harris Biden-Harris Administration’s agenda to ensure the affordability of the healthcare services and its expansion to the deprived communities. He made it clear that the primary objective of this rule is to protect healthcare consumers from unreasonably high costs. So, they can get much needed medical aid without any financial inconvenience.

The data, collected according to the key provision of this rule will be analysed carefully. In this way, the federal authorities will become able to know the industry’s market trends & costs related to air ambulance services. As a result, they can successfully address the challenges related to the high ambulance expenses.

No doubt, the air ambulances market is a complicated procedure that also involves unknown or fewer known costs. Meanwhile, the data (which is being collected through air ambulance services providers and issuers)_would bring all the costs related challenges under consideration. Which will help the HHS and other relevant federal departments to make a comprehensive and publicly available report_to enhance transparency and development of certain policies to address all cost challenges.

As the average cost of air ambulance transportation is between $36,000 to $40,000. However, the providers who administer the services of air ambulances are strictly prohibited from sending the surprise medical invoice to the beneficiaries of Medicaid or Medicare. In addition to this, according to the report of HHS Assistant Secretary of Planning and Evaluation (ASPE). Over 50 percent of the air ambulance trips are out of the network, which ultimately results in high copays. Most of the time, patients with private insurance are the victims of this issue.

However, the first rule proposed under the banner of the No Surprise Act doesn’t allow surprise bills for the patients. Who uses the out of network air ambulance services in the situation of a medical emergency or other certain reasons. Moreover, it will also limit the payments that patients have to pay by themselves, starting next year.

CMS Administrator Chiquita Brooks-LaSure said that: the federal agency is committed to ensuring the enforcement of the act. So, patients can seek healthcare services without the fear of surprise bills. While talking about the new consumer protections released. She said that this provision is critical to safeguard the patients from the devastating financial impacts. That may occur due to the unlawful higher medical bills. As the rule asks for complete information on how agents or brokers who assist consumers are compensated. It will eventually increase the transparency in the healthcare costs associated with air ambulance services.

Key Provisions of the No Surprise Act:

  • 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.

Wanted to know more about the newly proposed healthcare rules? Then stay in touch with the Medical Billing Benefits. It’s an authentic and reliable healthcare newswire, that keeps its readers updated about the latest developments in the medical industry. For further updates subscribe to our Newsletter.

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