Final Rule Issued On How Surprise Bill Disputes Should Be Settled
The Biden administration regulation continues to largely rely on median in-network rates in such dispute settlements, which providers have objected to. But one modification from an earlier plan says other information can shape arbiters' determinations of an out-of-network rate.
Axios:
Surprise Billing Rule Gets New Rules For Working Out Disputes
A year and a half after Congress protected patients from surprise medical bills, the Biden administration has finalized the process for deciding who'll actually pick up the tab. Billions of dollars are at stake — either for providers or for insurers and employers. (Reed and Bettelheim, 8/22)
Stat:
Biden Admin Stands Firm On Method For Resolving Surprise Billing Disputes
In a final rule published late Friday, the government said the entities that are meant to settle disputes between insurance companies and out-of-network providers must start their considerations with the median in-network payment rate for the service in question. Many providers don’t want the arbiters to rely on the median in-network payment rates, because they’ll get paid less if those in-network charges are taken into account. Already eight provider groups have sued the government on this point. (Bannow, 8/19)
Modern Healthcare:
No Surprises Act Dispute Resolution Rule Published
The regulation, which follows a court decision that struck down part of an earlier policy, instructs arbiters to consider both an insurer's median contracted in-network rate and additional information when determining the correct payment for a surprise bill, including for air ambulance services. The Health and Human Services, Labor and Treasury departments jointly published the final rule. (Tepper and Goldman, 8/19)
