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Biden administration releases interim final rule banning surprise medical bills

The final rule is an implementation of the No Surprises Act, which was passed by Congress last year.

July 2, 2021 / Jeff Lagasse, Associate Editor

The U.S. Department of Health and Human Services issued an interim final rule this week banning surprise medical bills and some out-of-network charges, which will go into effect on January 1, 2022 for providers and insurance plans that begin on or after that date.

The final rule is an implementation of the No Surprises Act, which was passed by Congress last year and seeks to protect patients from unexpected and often burdensome out-of-network bills. The Department of Labor, the Treasury department and the Office of Personnel Management were all co-authors of the interim final rule.

WHAT’S THE IMPACT

The rule contains several provisions, including a ban on surprise billing for emergency services regardless of where they’re provided, with such services treated as in-network services. It also bans out-of-network cost sharing higher than what a patient would pay in coinsurance and deductibles for in-network care.

The interim final rule goes further, banning out-of-network charges without advance notice and out-of-network charges for ancillary care at in-network facilities in all circumstances.

There are also repercussions for insurance plans that provide emergency services benefits. Any emergency service, according to the rule, should be covered without prior authorization, whether the provider is in-network or not. 

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Chris J. Stewart

Chris currently serves as President and CEO of Surgio Health. Chris has close to 20 years of healthcare management experience, with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help achieve better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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