Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Blogs
    • AI
    • Deals
    • Layoff Tracker
    • HIMSS 2023
  • Opinion
    • Breaking Bias
    • Commentaries
    • Letters
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • 40 Under 40
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - AI and Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Sponsored Video Series - One on One
    • Sponsored Video Series - Checking In with Dan Peres
  • Data & Insights
    • Data & Insights Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Politics & Policy
December 11, 2020 06:18 PM

Surprise billing reform picks up support with provider-friendly tweaks

Rachel Cohrs
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    House Ways & Means Chair Richard Neal (D-Mass.)

    Efforts to advance legislation that would curb surprise billing got a boost with House Ways & Means Committee Chair Richard Neal (D-Mass.) coming on board on Friday. A coalition of lawmakers at the center of the negotiations made some provider-friendly tweaks that helped entice the powerful committee chair.

    The same group of congressional leaders has been talking in circles on legislation for a year, since a bipartisan, bicameral agreement without Neal's support was left out of a year-end appropriations deal. But a push from House Speaker Nancy Pelosi's office (D-Calif.) pressured lawmakers to resurrect talks in the past week.

    The tri-committee group of the Senate health committee, the House Energy & Commerce Committee and the House Education & Labor Committee won the support of leaders of the House Ways & Means Committee, who had their own unique plan. Lawmakers are gathering stakeholder feedback before finalizing the deal blending the two approaches.

    "We have reached a bipartisan, bicameral deal in principle to protect patients from surprise medical bills and promote fairness in payment disputes between insurers and providers, without increasing premiums for patients or interfering with strong, state-level solutions already on the books," the eight committee leaders said in a joint statement.

    The legislation attempts to protect patients from surprise medical bills in emergencies and non-emergency situations where patients can't choose an in-network provider.

    Insurers and providers could negotiate on a payment for the remaining bill. If they can't agree, then they could use an arbitration process where the arbitrator is required to consider the median in-network payment rate for the service, the training of the provider, the parties' market share, prior contracting history, complexity of services, and other information submitted. Providers could batch claims that are paid by the same insurers.

    There is no cost threshold to enter arbitration, unlike last year's bill that had a $750 threshold. Arbitration can only occur for the same service every 90 days.

    The ban also applies to air ambulance providers. Air ambulance providers and insurers would be required to submit two years' worth of claims data to HHS.

    Consumers would have additional protection from surprise medical bills if an out-of-network provider doesn't provide estimated charges and a notification of their status 72 hours before.

    The new agreement eliminates a controversial benchmark payment that determined what insurers had to pay providers based on previously negotiated rates. Conservative groups had painted the benchmark payments as government rate setting.

    Providers have ramped up lobbying on the issue in recent days working to get favorable policy changes.

    It is unclear whether the new agreement will have the support of Senate Majority Leader Mitch McConnell (R-Ky.), but Senate Minority Leader Chuck Schumer (D-N.Y.) endorsed the bill on Friday.

    "I am pleased there is an agreement between the House and Senate Committees to end surprise medical billing and deliver real relief for every day Americans. There is now a consensus path forward on how to fix a broken system that harms patients. I hope to see it passed into law as soon as possible," Schumer said in a written statement.

    House Democrats will have a narrower majority next Congress, which could make pushing through controversial healthcare legislation difficult.

    The bill also includes other transparency provisions, including forcing plans to provide benefit explanations for scheduled services at least three days in advance and keep their directories up-to-date, and timely patient billing requirements.

    The ban could extend to uninsured individuals, as the HHS secretary is directed to establish an arbitration for the uninsured by 2022.

    Provisions limiting contract gaming tactics between hospitals and insurers were left out of the agreement.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    The U.S. Capitol building, seen from the Senate side.
    Hospital, health program cuts delayed under stopgap spending deal
    1920_masks-2_i.jpg
    New bill seeks safe staffing standards for Ohio nurses
    Most Popular
    1
    Centene to lay off 2,000 workers
    2
    How health systems are battling price-gouging allegations
    3
    Senate advances bill to temporarily aid hospitals, health centers
    4
    Elevance, Blue Cross Louisiana halt $2.5B proposed deal
    5
    Tower Health to sell urgent care centers, close others
    Sponsored Content
    Modern Healthcare Alert: Sign up for this breaking news email to be kept in the loop as urgent healthcare business news unfolds.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Help Center
    • Advertise with Us
    • Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Blogs
      • AI
      • Deals
      • Layoff Tracker
      • HIMSS 2023
    • Opinion
      • Breaking Bias
      • Commentaries
      • Letters
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • 40 Under 40
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - AI and Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Sponsored Video Series - One on One
      • Sponsored Video Series - Checking In with Dan Peres
    • Data & Insights
      • Data & Insights Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing