CMS bans surprise billing – Modern Healthcare

The Biden administration on Thursday unveiled the first in a series of rules aimed at banning surprise billing.

The interim final rule bars surprise billing for emergency services and high out-of-network cost-sharing for emergency and non-emergency services. It also prohibits out-of-network charges for ancillary services like those provided by anesthesiologists or assistant surgeons, as well as other out-of-network charges without advance notice.

“No patient should forgo care for fear of surprise billing,” HHS Secretary Xavier Becerra said in a statement. “Health insurance should offer patients peace of mind that they won’t be saddled with unexpected costs. The Biden-Harris Administration remains committed to ensuring transparency and affordable care, and with this rule, Americans will get the assurance of no surprises.”

While public health insurance programs like Medicare and Medicaid already prohibit balance billing, people with job-based coverage or individual health plans frequently and unknowingly accept care from an out-of-network provider before they are slapped with a surprise medical bill. The new rule aims to put a stop to that.

According to CMS, two-thirds of all bankruptcies in the U.S. are tied to medical expenses, and researchers estimate that 1 in 6 emergency department visits result in an unexpected bill.

“No one should ever be threatened with financial ruin simply for seeking needed medical care,” U.S. Secretary of Labor Marty Walsh said in a statement.

This first round of regulation applies to
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