Looking Ahead to 2022 New law attempts to curb surprise billing, creates new responsibilities for ASCs BY STEVE SELDE
On December 27, 2020, President Donald Trump signed H.R. 133, the Consolidated Appropria- tions Act, 2021, into law.
Among its many provisions, this law protects patients from surprise medi- cal bills from out-of-network pro- viders and creates an independent dispute resolution (IDR) process to resolve billing disputes between out-of-network care providers and health plans. In an effort to promote price transparency, it also creates new obligations for health plans and care providers. Many of the provisions mentioned
above go into effect in 2022 and will be implemented by the US Depart- ment of Health and Human Services (HHS) through rule-making pro- cesses. ASCA staff will include more information on these developments in ASCA’s weekly Government Affairs Update e-newsletter, ascassociation. org/govtaffairsupdate, as additional details become available.
Balance Billing Prohibition and the Dispute Resolution Process Beginning January 1, 2022, patients will be responsible for only the in- network cost sharing amount for cer- tain out-of-network services. These will include core and ancillary ser- vices provided by out-of-network providers at in-network facilities. The law creates a consent process patients can use to opt for out-of- network care. Once patients acti- vate that process, care providers are required to give patients a notice of their network status and an estimate of charges 72 hours prior to the pro- cedure. In the case of an appointment
made within 72 hours of a procedure, the patient must receive the informa- tion the day the appointment is made and consent to receive out-of-net- work care.
Leading up to 2022, it is impor-
tant that ASCs review their billing processes and make certain the net- work status for all the care providers who work in the center is assessed and updated. ASCs and other care providers could face federal civil monetary penalties of up to $10,000 and state enforcement action for bal- ance billing patients in violation of this law.
The law creates a formal structure and timeline for resolving billing dis- putes between out-of-network provid- ers and health plans. Health plans will have 30 days to deny or pay claims submitted by out-of-network provid- ers. Following the health plan’s action, an additional 30 days will be allotted for negotiations between the parties. If one of the parties is not satisfied with the results of the open negotia- tion period, the IDR process will then become available. There is no mini- mum amount required to go to arbitra- tion and providers can batch similar claims together.
ASC FOCUS MARCH 2021 |
ascfocus.org 23
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30
