The massive spending bill approved by Congress on Monday addresses the ramifications of the ongoing COVID-19 pandemic on the economy, including relief funding for providers and rules governing surprise medical bills.
Surprise medical bills occur when patients are admitted to a hospital in their health insurance network for inpatient or outpatient services but are also treated by out-of-network providers, such as laboratories, radiologists or emergency medicine physicians. Patients typically have no control over the decision to use these other providers and end up with “surprise” bills.
The legislation that passed the House and Senate includes provisions that require providers and insurers to negotiate payments in these situations.
In a statement, American Hospital Association (AHA) President and CEO Richard Pollack applauded the surprise billing measure as being less unfavorable to providers than other proposals. “We also applaud Congress for rejecting attempts to base rates on public payers, including Medicare and Medicaid, which historically pay far less than the cost of delivering care,” Pollack said.
In a study, the Health Care Cost Institute calculated that the share of in-network hospital admissions including at least one surprise claim ranged from 1.7 percent in Minnesota to 26.3 percent in Florida. Among specialty categories included in the study, independent labs billed out-of-network rates as part of an in-network admission 22.1 percent of the time.
The federal legislation also provides additional funding related to COVID-19 patients, vaccination and testing efforts, according to the AHA.
Other measures included in the bill are:
• Changing the Provider Relief Fund (PRF) reporting guidelines to allow hospital systems to move targeted PRF distributions within their system and allowing providers to use any reasonable method to calculate lost revenue.
• Eliminating cuts to the Medicaid disproportionate share hospital (DSH) program for the next three years.
• Allowing rural hospitals to provide emergency and observation services without the provision of inpatient services.
