Legislation to Address Surprise Billing Progressing in Congress

Publication Date: Mar 3, 2020

With the 2020 elections on the horizon, Congress is continuing its efforts to enact legislation to address surprise billing. In February, two House Committee’s approved separate bills on this issue. On February 11, the House Education & Labor Committee approved, by a vote of 32-13, its approach to surprise billing reform. While the measure protects patients from surprise medical bills from out-of-network providers, healthcare providers and medical specialty societies contend that the Education bill favors insurance companies by setting a high threshold ($750) for when providers could seek arbitration to appeal payment rates perceived as insufficient. This would effectively block most laboratory and pathology services from arbitration.

The Education bill would set payment rates at the median amount paid for that service in a defined geographic area. Indeed, a number of the members of the House Education Committee that opposed their committee’s bill reportedly favor legislation that was unanimously approved by the House Ways and Means Committee on February 12. This legislation includes provisions that ASCP supports, including an independent dispute resolution process, and no monetary arbitration threshold. Additionally, the Ways and Means legislation does not have a benchmark payment rate and includes patient protections supported by ASCP. This approach, which is favored by other medical specialty societies, allows providers to seek independent review of payment rates perceived as inadequate. As Congress works towards compromise legislation, ASCP will be working with the AMA, CAP and other medical societies on a surprise billing fix that protects patients and ensures fair payment.

Other articles in the March 2020 ePolicy News:

To read more articles from ePolicy News click here.

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For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.

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