Surprise Balance Billing
States are taking the lead to address surprise balance bills – charges for unexpected, out-of-network medical care – by enacting consumer protection laws that range from strict requirements for network service disclosures to outright bans on balance billing in certain circumstances. NASHP is tracking state efforts to mitigate surprise billing and analyze the outcomes of these measures.
Results from a new RAND Corporation study – Nationwide Evaluation of Health Care Prices Paid By Private Health Plans – show commercial payers reimburse hospitals about 2.5-times more than does Medicare. As expected, hospital officials responded, claiming that public payers underpay for medical services and that it is inappropriate to challenge hospitals now as they battle […]
Facility fees – designed originally to compensate hospitals for “stand-by” capacity required for emergency departments and inpatient services – are increasingly added to bills for diagnostic testing and other routine services and are raising health care costs. One state employee health plan’s claims show that facility fees charged for COVID-19 testing conducted in outpatient hospital […]
Last week, over 1,000 state health policy leaders and others from every state joined the National Academy for State Health Policy’s (NASHP) first-ever virtual state health policy conference to discuss a path forward during an unrelenting pandemic and profound budget challenges. As one state official noted, “This was a chance to lift my eyes from […]
Model Act Summary: This model legislation prohibits site-specific facility fees for services rendered at physician practices and clinics located more than 250 yards from a hospital campus. It also prohibits all service-specific facility fees for typical outpatient services that are billed using evaluation and management codes, even if those services are provided on a hospital […]
Year after year, hospitals account for the largest expenditure of US health care dollars, followed by physician and clinical services, of which over half are owned by a hospital or a hospital-affiliated health system. To address rising health care costs, state policymakers and the public need detailed hospital financial information to understand a hospital’s assets […]