For those who work in the healthcare industry, surprise billing is not a new concept. This practice impacts patients seeking all types of medical attention, and has been a topic of discussion among lawmakers in recent months. Attention from both the federal government and healthcare stakeholders has propelled this issue into one that might soon have a resolution, because both the House Ways & Means Committee and other significant groups in Congress have been working to find a solution. Congress has been at a stalemate for months regarding this issue, but recent proposals have sparked a new wave of negotiations and conversations by lawmakers to come to a resolution before the December 20th deadline. Keep reading to learn more about this issue and where it currently stands in Congress.
What is Surprise Billing?
Surprise medical billing is a practice that occurs very often for those seeking medical care- it is when a patient receives care from a doctor or hospital not covered by their insurance and is then met with a massive and unexpected bill. In most cases, someone who makes an appointment with a doctor is inclined to choose one that is within their insurance plan, but when seeking emergency care, this may not be the case. Patients may not be in the right state of mind to double-check the hospital they visit or the doctor that treats them or their family member to ensure they are covered. Even if the hospital is in the patient’s network, every member of their care team may not be, and most patients seeking urgent medical care are not prepared to stop the doctor who is planning on treating them to ask if they are covered by insurance. This issue also arises when patients are simply taken to the nearest hospital, which may not be in their network, joining the out-of-network cost of ambulance transportation.
Ways & Means Chair Proposal
In early October of this year, the House Ways & Means Committee sparked conversation about surprise billing when Chairman Richard Neal called on the Department of Health and Human Services, the Department of Labor, and the Department of Treasury (along with key stakeholders) to work together to standardize this payment issue. Chairman Neal expressed a desire to have a resolution by the end of 2019, with recognition of the fact that it has been difficult for lawmakers to find a solution that will appease both providers and insurers while protecting patients from surprise bills.
Following the proposal from the Ways & Means Committee, negotiations on legislation related to surprise billing continued in the House and Senate. A deadline was set for December 20th, as an agreement decided upon by that date would be able to be included in a government funding package. Lawmakers in both political parties have been engaging in discussions about the issue, but major obstacles still stand.
Challenges and Opposition
Most of the debate at this point comes from the decision of how much an insurer will have to pay the doctor or hospital once the patient is taken out of the picture. A proposal has been made by the Senate Health Committee and House Energy and Commerce Committee that a payment rate should be set based on the average price of the service, but doctors and hospitals have shown resistance to that idea. They prefer an outside arbitrator being the one to decide the amount of payment, but experts believe that this approach could increase healthcare costs. In general, doctors and hospitals have been lobbying against the proposals set by Congress, stating that it would cause cuts to their payments. With this opposition in mind, the committees have been seeking a way to please all parties involved, but this may cause clashes with lawmakers who disagree. As previously mentioned, the Ways & Means Committee is still working on its own bill, which would be a competitor to any plans created by the House Energy and Commerce Committee.
Surprise Billing Legislation History
Unfortunately, it has not been uncommon in the past for the government to be unable to come to an agreement on how to handle surprise billing. It has been proven to be extremely difficult to please all parties who have a stake in this issue, as this is a decision that will impact insurers, doctors, and patients. Advocates for change to this practice have shown frustration over the fact that it has taken so long for Congressional leaders to come to a decision. With many patients facing surprise bills that could reach tens of thousands of dollars, advocacy groups are urging Congress to come to a decision and meet their deadline for the sake of everyone involved.
Focus on Your Practice with Help from HIS
We understand that Congressional debates and discussions about healthcare industry issues can be difficult to keep up with. Along with keeping you up to date on the latest issues affecting the industry, we proudly offer a number of services meant to improve efficiency and boost profitability for your practice, all while you focus on the most important thing- your patients. We offer practice management services for orthopedic and radiology practices countrywide, as well as revenue cycle management, coding education, digital marketing, and more. We have over 30 years of experience managing and advising physicians and practices, and we will work to bring your practice to the next level and set you up for long-term sustainability. Please contact us with any questions you have about what Healthcare Information Services has to offer- we look forward to hearing from you.