Becerra says unexpected billing rules force overcharged doctors to accept fair prices

HHS Minister Xavier Becerra told KHN that when the new regulations on accidental medical bills come into effect in January, overpriced doctors and other medical providers who cannot charge a reasonable fee for their services may go out of business, which is a good thing. Regulations.

The proposed rules are implemented on behalf of the Biden administration No accidentWhen one or more of their providers unexpectedly exceeded their insurance plan network, Congress passed the bill to save patients from paying surprisingly high bills.

HHS has developed an accidental billing resolution process in the new rules

The law protects patients from these bills, requiring providers and insurance companies to negotiate how much they should pay to the doctor or hospital, and if they can’t agree, arbitrate.However, doctors’ groups and medical associations lashed out during this period final rule HHS announced last month that they support insurance companies during the arbitration phase. This is because, although the rules tell arbitrators to consider many factors, they are instructed to start with a benchmark determined primarily by insurance companies: the median rate negotiated by providers within the network for similar services.

The group of doctors said that giving insurance companies the upper hand will allow them to lower their payment rates and may force doctors to withdraw from the network or even close their business, thereby reducing their chances of access to health care.

Unexpected billing rules make providers angry with insurance company-friendly policies

Becerra said the department has heard these concerns, but the bottom line is to protect patients. He said that those medical service providers that use complex systems to charge high fees will have to bear their share of the cost, and if they can’t, they will shut down.

“I don’t think that when someone overcharges, it must now cause harm to the overcharger [accept] A reasonable price,” Becerra said. “Those who overcharge either have to tighten their belts and do better, or they can’t persist in this industry. “

“It is unfair to say that we have to let someone dig us before they can do business,” he added.

Nevertheless, Becerra said that he did not foresee a wave of closures or reduced consumer visits. Instead, he suggests that a competitive, market-driven process will find a balance, especially when consumers are more aware of what they are paying for.

“We are willing to pay a reasonable price,” he said. But he emphasized, “I will pay for the best, but I don’t want to pay for the best, and then pay three times the cost, and then be blinded by the bill.”

Becerra also pointed to a report on accidental medical bills that HHS is scheduled to release on Monday and provided to KHN in advance, highlighting the impact of negotiation and arbitration laws that have come into effect in 18 states.

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The report summarized previous research and found that people received an average of $1,219 for an anesthesiologist, $2,633 for a surgical assistant, $744 for a childbirth, and $24,000 for an air ambulance.

In states such as New York and New Jersey that use benchmarks similar to those recommended by doctors for HHS, the report found rising costs. New York has a “baseball-style” system in which the arbitrator chooses between the offer provided by the provider and the insurance company, although the arbitrator is told to consider the offer that is closest to 80% of the charge. The report found: “Because the fees charged by suppliers are usually much higher than the actual negotiated rates, this method risks a significant increase in overall costs.” In New Jersey, billing fees or “usual and customary” rates are considered .

Becerra said of the doctor’s preferred method: “When the arbitration process is completely open and without boundaries, the cost of healthcare will eventually rise, not fall.” “We want to reduce costs. Therefore, we want to build a system, Help provide guidance so that we can remain efficient, transparent and cost-effective.”

The Congressional Budget Office estimates that the system chosen by the Biden administration is expected to reduce insurance premiums by 0.5% to 1%.

“Everyone has to pay a little to get to a good place,” Becerra said. “I hope that the sweet spot is the patient… the place to be freed from that food war. If the food war continues, the arbitration process will help resolve it in an effective way, but it will also reduce costs.”

Although the government chose a benchmark that doctors and hospital groups don’t like, the law does stipulate that other factors should be considered, such as the provider’s experience, the market, and the complexity of the case. Becerra said these factors help ensure fairness in the arbitration.

“All we did was make a rule and say’show evidence,'” Becerra said. “It must be relevant and important evidence. Let the best people win in the fight for arbitration.”

The interim final rule was released on October 7, giving stakeholders 60 days to comment and seek changes.more than 150 members of parliamentMany of them are doctors, and HHS and other relevant federal agencies have been asked to reconsider before the law goes into effect on January 1. Legislators accused the government of failing to abide by the spirit of compromise made by Congress when it passed the law.

The rules so far tend to take effect with little or no changes, but Becerra said his department is still listening. “If we think it is necessary to make any changes, we are ready to do so,” the secretary said.

The HHS report also pointed out that the law requires a large number of reports to be submitted to regulatory agencies and Congress on a monthly and annual basis to determine whether the regulations are malfunctioning or have caused the adverse consequences of a doctor’s warning.

Becerra said he believes that these rules strike the right balance, not for insurance companies or doctors, but for people who need medical care.

“We want it to be transparent so that we can bring more competition and keep costs down-not only to payers, insurance companies, not only providers, hospitals or doctors, but especially patients.” He said.

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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