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What the CMS surprise-billing proposal means for ASCs

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CMS is taking on surprise billing with a proposed final rule released July 2.

The proposal is based on provisions of the No Surprises Act that Congress passed Dec. 27, and most provisions wouldn't take effect until Jan. 1, 2022.

Key elements for ASCs:

1. The proposal would mandate that cost-sharing, such as coinsurance and deductibles, be based on in-network provider rates.

2. Surprise billing for ancillary services at in-network facilities would be prohibited, including anesthesia services.

3. Health insurance companies would have to make a payment or provide a notice of denial to providers within 30 days of receiving a clean claim.

4. Providers would be required to publicly post information about surprise-billing protections, and patients would be allowed to waive those protections if they are willing to receive services out of network. Providers then would need to develop a process for getting patient consent for balance billing.

ASC administrators said they have noticed patients becoming more informed about the difference between in-network and out-of-network billing, and want to make sure they won't get surprise bills.

"I've been impressed with the increased knowledge patients have had about their health insurance coverage," said Celia Smith, RN, administrator of Houston Premier Surgery Center. "Many patients are verifying if our center and providers are in network with their payer. Patients are also well-versed about their deductibles and out-of-pocket expenses."

Click here for more information about the proposed rule. 

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