Despite federal regulators' renewed efforts to assure hospitals that offering discounts to the uninsured does not violate regulations, some providers remain confused about when such practices may expose them to federal scrutiny.
Earlier this year, HHS Secretary Tommy Thompson bluntly said nothing in the law prevented hospitals from giving price breaks to those who cannot pay their hospital bills.
But during an informal question-and-answer session held by HHS and its office of the inspector general last week in Washington, it became evident that providers remain wary that offering such discounts could get them in trouble. More than 1,600 providers participated in the session, either in person or by telephone.
"When you have 1,600 people calling in, clearly there are still a lot of questions out in the field," said Richard Wade, a spokesman for the American Hospital Association.
This week, a House Energy and Commerce Committee subcommittee will hold a hearing on hospital billing and collection practices. For more than a year, hospitals have been on the defensive over the issue amid reports of overly aggressive billing. Last December, AHA President Richard Davidson asked Thompson for guidance on billing the uninsured and for safe-harbor protection for hospitals that offer discounts or waive charges for the uninsured.
Thompson responded with written guidelines that in essence said that under federal regulations, hospitals already clearly can offer financial help to those who cannot pay their hospital bills and turned down the AHA's request for safe-harbor protection.
Last week, officials reiterated that stand. "Simply put, nothing in the OIG rules prohibits or restricts hospitals or other providers from offering discounts to uninsured patients," said Vicki Robinson, chief of the industry guidance branch of the inspector general's office. In a meeting with reporters, Thompson also said the matter of how hospitals can discount for the uninsured was "pretty well closed."
But if last week's question-and-answer session was any indication, providers remain flummoxed about even the most basic issues. The first question asked was whether providers can offer across-the-board discounts to the uninsured regardless of their financial status, a question that was repeated several times in different ways.
The answer: generally, yes.
In trying to give hospitals flexibility in creating discount policies for the uninsured, officials may also have created new gray areas hospitals are having trouble navigating, providers said.
"There's still skittishness because this is something that is still being left to the business judgment of the hospitals, and that's a double-edged sword," said Alan Aviles, senior vice president and general counsel for the 11-hospital New York City Health and Hospitals Corp.
Jim Alexander, technical director of the Healthcare Financial Management Association, said providers are particularly wary of doing anything that can be interpreted by the inspector general as being in violation of federal antikickback statutes. The inspector general "is a stickler with regard to the letter of the requirements," he said.
-with Jeff Tieman