AHA Urges Agencies to Revise Surprise Medical Billing Rule

At a Glance

The American Hospital Association (AHA) appreciates the opportunity to comment on the second set of interim final regulations (IFR) implementing the No Surprises Act. Hospitals and health systems strongly support protecting patients from gaps in their health care coverage that may result in unanticipated medical bills, and we look forward to working with you on implementation of these critical protections.

The IFR issued by the departments of Health and Human Services (HHS), Labor, and Treasury, along with the Office of Personnel Management (departments) address several provisions in the law, including the independent dispute resolution (IDR) process providers/facilities and plans/issuers may use to adjudicate reimbursement disputes, the good faith cost estimates providers must share with uninsured or self-pay patients for scheduled services, a process to resolve disputes between uninsured/self pay patients and providers about amounts charged, and an external review process as part of the oversight of health plan/issuer compliance.

The importance of these provisions and the patient protections that were addressed in earlier regulations implementing the No Surprises Act cannot be overstated. No patient should be fearful of receiving a bill for out-of-network care that they received during an emergency or when they reasonably could not have known the network status of the provider. In addition, hospitals and health systems are committed to helping patients access the financial information they need when scheduling or planning for care. We look forward to working with the departments to implement these patient protections.

• Our priority comments request that the departments:
• Restore the independence of the IDR entities by not distorting the process in a manner that negatively impacts patient access to care, undercompensates providers and has other consequences far beyond surprise medical bills.
• Increase the efficiency of the IDR process by allowing for more flexibility in the batching of claims.
• Align the various price transparency policies to ensure patients do not receive conflicting estimates and to maximize efficiency in the health care system, including by allowing providers to utilize patient cost estimator tools, when available, for patients who are shopping for care.
• Work with all stakeholders to develop the necessary operational solutions, including transaction standards, to enable accurate, efficient implementation of both the surprise billing protections and good faith estimates.

Ensure that all rules and operational processes are in place and have been tested prior to Jan. 1, 2022 to ensure patient protections can be implemented on time.

View the detailed comments below.