Skip to Main Navigation Skip to Main Content Skip to Footer
search play2 play3 facebook twitter linkedin2 cross
ASCP
  • DASHBOARD
  • STORE
  • LOGOUT
  • STORE
  • LOGIN
Menu
  • My Role
  • Membership
  • Learning
  • Get Involved
  • Careers
  • About ASCP
  • Board of Certification
  • News
  • News
  • News Archive
  • Groups
  • Jobs
  • ASCP
  • News Archive
  • News Detail

Congress Curbs Surprise Billing in Omnibus Coronavirus Relief Bill

Publication Date: Jan 8, 2021
A measure to curb surprise medical bills was signed into law on December. 27 as part of the coronavirus relief and economic stimulus bill. Starting in 2022, patients won’t receive surprise bills for emergency care or for nonemergency care provided at an in-network hospital when they are unknowingly cared for by an out-of-network physician, laboratory or other healthcare provider. Patients will only be responsible for the deductible and copayment amounts under the in-network terms of their insurance plans. For the uninsured, the bill requires the secretary of the Department of Health and Human Services (HHS) to create a provider-patient dispute resolution process. ASCP strongly supports holding patients harmless in billing disputes between providers and payers.
In addition, the new law allows patients who wish to seek out-of-network care to consent to a cost estimate provided by the clinician 72 hours prior to treatment. This is allowable only in nonemergency situations and prohibits many types of physicians (pathologists, radiologists, anesthesiologists, laboratories, etc.) from the practice. 

Further, the new law carves out some middle ground in terms of determining payment amounts. Insurers and providers have 30 days to negotiate the payment of out-of-network bills. If that fails, the claim then goes through an independent dispute resolution (IDR) process, which is strongly supported by ASCP. (Click here for details on recent ASCP advocacy on surprise billing.) The new law does not specify a benchmark payment, but bars the use of “billed charges” during arbitration as these charges are generally far higher than negotiated rates. 

Additionally, in a last-minute change favoring hospitals and physicians, Medicare and Medicaid rates were also barred from consideration during arbitration. This is expected to favor clinicians as government payments are often much lower than negotiated insurance rates. The legislation also states that negotiators can consider the median in-network prices paid by each insurer for the services in dispute. Other factors negotiators may consider include whether the provider tried to join the insurers’ network, and how sick the patient was compared to others. 

ASCP has long advocated for a fair solution to surprise billing that not only protects patients, but also reimburses pathologists and other physicians in a fair and reasonable way. (Click here for ASCP’s policy statement on surprise billing.) For example, because of ASCP’s reputation as a patient-centric organization, the HHS sought out ASCP’s counsel to outline pathologists’ and patients’ perspectives on this issue. While this legislation is not perfect (no law is), it serves as a compromise where patients ultimately win. It remains to be seen how federal legislation will affect state laws, with some policy experts anticipating that states will ultimately defer to federal law. (More than 30 states have enacted some type of surprise billing legislation, but only 17 are considered comprehensive.
 
To learn more about ePolicy News and access past newsletters and articles, click here. 

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

sponsors_hologic

ASCP ePolicy News is supported by an unrestricted grant from Hologic.

  • My Role
    • Pathologist
    • Resident
    • Lab Professional
    • Program Directors
    • Student
  • Membership
    • Renew Membership
    • Become a Member
    • Get Involved
    • Rewards
    • Member Center
  • Learning
    • Certificate Programs
    • Attend Live Events
    • Explore Books and Journals
    • Quality Improvement Education
    • Access My Education
    • ACCME
    • CC Resources
    • CMP Resources
    • ASCPedia
    • Featured Education
    • Immuno-Oncology
    • ASCP Annual Meeting
    • ASCP Virtual Town Hall Series
    • Inside the Lab
  • Get Involved
    • Get Recognized
    • Receive Awards
    • Serve Your Community
    • Center for Global Health
    • Serve Your Profession
    • Partners in Cancer Diagnosis
    • Institute for Science Technology & Public Policy
    • Choosing Wisely
    • Patient Champions
    • Discover Opportunities
    • Apply to Volunteer
    • Ambassadors
    • ASCP Mentorship Program
  • Careers
    • Find a Job
    • Post a Job
    • Learn About Careers
    • Discover Fellowships
    • Work at ASCP
  • About ASCP
    • Our Mission
    • Supporting Our Members
    • Our Community Efforts
    • ASCP Foundation
    • Contact ASCP
    • Media Relations
  • Board of Certification
    • Get Credentialed
    • Stay Credentialed
    • Verify Credentials
    • Program Directors
    • About BOC
    • Apply Now/Check Status/Update Info
    • Manage Your BOC Account
    • Declaration & Complete CMP
  • News
    • ePolicy News
Chicago (Headquarters)
33 West Monroe Street, Suite 1600, Chicago, IL 60603

Privacy Policy 

Terms of Use

Follow Us

Copyright ©2021 by American Society for Clinical Pathology. All Rights Reserved.