Week 5 HSM541 Written assigment
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Week 5: Written Assignment:
American Hospital Association (AHA) Issues for You: Surprise Billing Team Member: Course Title: Health Services System
Course Number: HSM541
April 2, 2023
Professor’s name: Dr. Tammy Cagle
American Hospital Association (AHA) Issues for You: Surprise Billing Founded in 1898, the American Hospital Association (AHA) is a national organization that represents and serves all types of hospitals, health care networks, their patients, and communities. Consisting of 5,000 hospitals, health care systems, networks, other care providers, and 43,000 individual members, the AHA provides education for health care leaders and is a source of information on health care topics and trends. This written paper aim to discuss one of the issues that the AHA is addressing for patient wellness, such as "surprise billing," its impact on the US health care system, the issues associated with this problem and a recommendation to solve it. The No Surprises Act was signed into law on Dec. 27, 2020, as part of the Consolidated Appropriations Act of 2021 (H.R. 133; Division BB – Private Health Insurance and Public Health Provisions). The No Surprises Act addresses surprise medical billing at the federal level. Most sections of the legislation go into effect on Jan. 1, 2022, and the Departments of Health and
Human Services, Treasury, and Labor are tasked with issuing regulations and guidance to implement several the provisions. (AHA, 2023)
(Richman Barak; Hall Mark; Schulman Kevin, 2021)
Indicates that, The No Surprises Act addresses many of the billing behaviors that have attracted widespread outrage in the United States. It prohibits out-of-network providers from charging patients amounts that exceed the patient’s in-network rates for emergency medical care, air-ambulance services, and nonemergency and ancillary services delivered by out-of-network providers at in-network facilities. Such billing practices have traditionally imposed catastrophic prices on vulnerable patients without their knowledge or ability to challenge the rates. Instead of allowing providers to recover from patients amounts listed on their charge sheets, which far exceed negotiated
commercial rates and which providers unilaterally set, the Act requires providers and insurers to arbitrate, while that keeps the patient financially unharmed.
The No Surprises Act also provides important protections for patients seeking non-
emergency care from out-of-network providers. And out-of-network providers may charge a patient more than their copayment amount for in-network care only if they notify the patient of the estimated amount at least 72 hours prior to the care and receive the patient's written consent.
The No Surprises Act purpose was ending the pernicious practice of surprise billing for out-of-network care, but the country’s recent experience with balance-billing prohibitions for Covid-19 testing and treatment offers an ominous warning. The Coronavirus Aid, Relief, and Economic Security (CARES) Act barred providers from collecting copayments and pursuing balance bills for coronavirus testing and treatment in exchange for receiving bailout funds. Reports have documented a nationwide persistence of surprise bills for Covid-related care. However, reports have documented a nationwide persistence of surprise bills for Covid-related care. The continued existence of seemingly illegal billing has been attributed to missed covid-19 diagnoses, coding, human error, billing-related confusion, simple non-compliance with federal regulations, and various loopholes. (Richman Barak; Hall Mark; Schulman Kevin, 2021)
According to a investigation completed by (Association-BCBSA, 2023)
on November 16, 2022, about the impact of the No Surprises Act (NSA) in protecting consumers from surprise medical bills and highlights the excessive use of arbitration by health care providers; more than nine million claims from health care facilities and providers were subject to the protections of the
law, which limit out-of-pocket costs for consumers. The number of those claims disputed by providers or facilities has far exceeded the federal government's initial prediction.
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The same study estimates that the number of disputed out-of-network claims submitted to
independent dispute resolution (IDR) was 275,000 across those 90,000 disputes, indicating substantial use of batching and a result of many providers sending dozens of claims at once to IDR, causing significant backlogs to the system. A single dispute as reported by
Centers for Medicare & Medicaid Services (CMS), could represent a batched dispute of many claims or a group of several claims for a single visit. The Certified IDR Entities must review each claim individually, meaning a high volume of claims across many disputes increases the burden on IDR entities and drives higher health care costs due to associated fees.
The large number of disputes initiated, including thousands of batched claims and many found to be ineligible, indicates many health care providers who were previously able to balance bill patients may now be utilizing the Federal IDR Process to collect above-market reimbursement amounts. Should this trend continue, health care costs could unnecessarily increase.
All the mentioned above, makes very clear that in the health care sector, making certain practices illegal is not enough to prevent them from occurring, that’s why the support of t
he hospital and health system field in protecting patients from surprise medical bills is very important. The American Hospital Association (AHA) and its affiliates are uniquely positioned to respond to a broad array of local and national issues like Surprise billing and others, by providing hospitals with assistance in their decisions with different topics, ideas, information, education, and consulting services. Moreover, in the specific matter object of this study, strongly support the legislation to fight against surprise billing, implementing different resources such as
taking part of not surprise litigation acts in the courts, providing information about all the regulation about this topic, articles, and patient billing guidelines. Lastly, my recommendation to continue the fight against surprise billing is that those who
feel that has been or are being affected by this and believe that have been billed incorrectly, make use of all the tools that the government and different organizations like AHA have put in place available to advocate for them, like for example, they may contact the New York State Independent Dispute Resolution (IDR). They can visit the AHA website, or the New York Department of Financial Services website for additional information regarding their rights on surprise medical bills, because is very important to know and understand their rights under the federal law: The No Surprises Act
. References
AHA, A. H. (2023, March 29). Surprise Billing
. Retrieved from aha.org: https://www.aha.org/surprise-billing
Association-BCBSA, A. a. (2023). No Surprises Act Prevents More Than Nine Million Surprise Bills Since January 2022. Medical Benefits Trade Journal
, 9-10. https://www.proquest.com/healthmanagement/docview/2781182513/fulltextPDF/
181054EF2BA04400PQ/1?accountid=44759
Richman Barak; Hall Mark; Schulman Kevin. (2021). The No Surprises Act and Informed Financial Consent. The New England Journal of Medicine Preview publication details
, 1348-1351. https://www.proquest.com/healthcomplete/docview/2579719712/64C77E0EA88B4ED6P
Q/3?accountid=44759#
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