HHS Now Introduces New Surprise Bill Compliance Rules

The extension to the No Surprise Bill has released a month ago, which is supposed to prohibit the surprise bills for patients. A step in the direction of optimizing medical billing services!

HHS (United States Department of Health and Human Services) and other federal departments came up with a notice known as NPRM (Notice of proposed rulemaking). This regulation will allow authorities to penalize clinicians and billing service providers for up to $10,000.

NPRM Validates the Existing Penalties for Surprise Bill Violation

To be exact, the new regulation comes as the Reporting Requirements Regarding Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement. And it codifies penalties for PHS (Public Health Service) Act for violations under Part E.

The new rule will allow putting sanctions and fines as civil monetary penalties. It will also empower health insurance payers to keep a check on surprise medical bills.

The Explanation of the NPRM Law

The new law also explains a framework to establish authority over healthcare service providers, hospitals, and providers of air ambulance services.

How will HHS Put the Penalty over a Surprise Bill?

HHS will also have the authority to ask for any documents in case of a complaint, and it can happen within six years of the claim processing, compilation, and submission. Thus, medical billing services would also be playing a very important part, and they must have all documentation to support their claim.

Moreover, it is also to keep in mind that the penalty and the complaint repercussions would be judged over the level of violation.

Action for Air Ambulance Service Provider

If air ambulance service providers fail to provide any document, they can receive a penalty of up to $10,000 under the Social Security Act.

The data includes:

Payer data
Claim denials
Air ambulance bases and aircraft
Transportation and medical costs
Number and nature of air ambulance transports

The rule is particularly for the air ambulance service providers as it is a consolidated market.

These rules established by the Biden-Harris administration would allow authorities to get any data and read the market trends. Moreover, they would be able to give their insights based on the available data.

Conclusion

It is indeed a great step in terms of preventing patients from the hideous surprise bills. Besides, it can make healthcare services affordable for everyone, be it providers, payers, or medical billing services. Ultimately, this law grants rights to CMS to take action against facilities that do not comply with the regulations.

We could expect some more laws to come as an extension to this. This Act will go into effect from January 1, 2022.