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The Centers for Medicare and Medicaid Services (CMS) in conjunction with the Departments of Health and Human Services (HHS), Labor (DOL), Treasury (collectively, the Departments), and the Office of Personnel Management (OPM) has issued an interim final rule with a comment period that seeks to implement the No Surprises Act aimed at surprise medical billing.
Read MoreThe No Surprises Act was quietly a part of the omnibus spending bill that was signed into law on December 27, 2020 has caught several people by surprise (no pun intended). The law was created with the goal of shielding patients from receiving surprise medical bills after an emergency room or provider visit. Any disputes would now be left to their plan and provider to resolve via arbitration.
Read MoreSurprise medical billing is an issue that has been widespread for a while, but due to social media and more intense scrutiny, we are now seeing the effects of how common this problem is among patients accessing our healthcare system. According to a study by Kaiser “roughly 1 of every 6 emergency room visits and inpatient hospital stays in 2017, patients came home with at least one out-of-network medical bill.” The question is what is surprise medical billing?
Surprise medical bills generally have two components. The first component is the higher amount the patient owes under her health plan, reflecting the difference in cost-sharing levels between in-network and out-of-network services. The second component of surprise medical bills is an additional amount the physician or other provider may bill the patient directly, a practice known as “balance billing.”
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