In light of the recent signing of the Covid relief and governmental spending bill we wanted to update physicians on the upcoming effects for surprise billing, that will begin taking place in 2022.
The changes for surprise billing largely fall in to three categories; lessen surprise bills, allow consumers to agree to balance billing, and payment settled in negotiations. These changes also bring the likelihood that some state laws will be changing to accommodate the new bill.
First steps of change will come with the push to lessen surprise bills. This is primarily consumer facing as it stops them from receiving balance bills from emergency care, air ambulance transport, or when they receive non-emergency care at an in-network hospital but are treated by an out-of-network physician or lab. Instead of the consumer receiving the balance bill medical providers will have to work out payment with insurers.
Even with the stoppage of most balance bills it is possible for consumers to agree to balance billing. This is to help consumers who would like to see an out-of-network physician. In these cases physicians must provide a cost estimate and get patient consent 72 hours before treatment, or the day the appointment is made in shorter turnaround situations. The legislation only allows this option for non-emergency circumstances and bars many physicians from the practice.
The largest change that will come from this reduction in surprise bills is that the patients will be held harmless and this the providers will need to work with insurers on the payment. Insurers and providers will have 30 days to negotiate payment for out-of-network bills. If that fails the process will move to an arbitrator, who will have the final say. “Billed charges” as well as consideration of Medicare and Medicaid prices will be barred in arbitration.
We will be keeping up with the changes and adjustments as more information is released and are in the process of compiling the existing data now. Please contact us if you have any inquires or would like to discuss the changes further.