How ASCs play into attempts to end surprise billing — 5 insights

Ending surprise billing has become a top bipartisan issue, and although no bill has been introduced in this Congress, HealthAffairs reports new legislation could be heavily influenced by past failed attempts.

What you should know about past attempts and how they relate to ASCs:

1. The 115th Congress (2017 to 2019) saw two separate attempts to end surprise billing. Two bills were introduced in the U.S. House, with two companion bills in the U.S. Senate.

2. Three of the bills targeted hospitals and/or healthcare facilities. One bill included ASCs. All four bills incorporated a notification and consent process but only two bills had a dispute resolution process. All bills prohibited balance billing and three of the four addressed cost sharing.

3. Like hospitals, in-network ASCs may include out-of-network surgeons or anesthesiologists. A recent analysis said up to 15 percent of outpatient service days included an out-of-network claim. These claims were most often related to in-network centers using out-of-network anesthesia groups.

4. State-level laws in New York, California and New Hampshire recognized the unique situation ASCs were in and put language in their laws to address surprise medical bills from the ASC setting.

5. The authors conclude, "Those crafting comprehensive federal legislation would do well to build on the strengths of each of the last Congress’s policy proposals and take lessons from existing state laws as they work toward protecting Americans from predatory medical billing."

To read the entire breakdown, click here.

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