If passed, the bill would require significant changes to current practices regarding how off-campus hospital services are billed. Under the new regulations, hospitals would be mandated to use unique health identifiers established for off-campus outpatient departments, and claims for services provided there need to be submitted using specific billing formats (HIPAA X12 837P transaction or CMS 1500 form). The implications of this bill are broad, as it is expected to reduce improper billing cases and ultimately protect patients from being charged excessively for services that should be covered under the existing Medicare guidelines.
Summary
House Bill 2863, titled the 'Preventing Hospital Overbilling of Medicare Act', aims to amend title XVIII of the Social Security Act and title XXVII of the Public Health Service Act. Its primary focus is to address the issue of incorrect billing by off-campus hospital locations, particularly in relation to Medicare billing practices. The bill seeks to establish protocols for how services are billed by hospitals that operate off-campus outpatient departments, implementing a framework meant to inhibit overbilling and ensure that Medicare payments are site-neutral.
Contention
Despite its positive intentions, the bill may face debate and contention over its implementation and the logistical challenges it poses to healthcare providers. Stakeholders might raise concerns over the administrative burdens that such stringent billing protocols could impose on hospitals, particularly smaller facilities that may lack the resources for compliance. Additionally, as healthcare remains a deeply polarizing issue, differing opinions on how best to manage hospital billing practices are likely to emerge, focusing on whether the provisions sufficiently address the variety of billing practices across different states and healthcare settings.
To amend title XVIII of the Social Security Act to require each off-campus outpatient department of a provider to include a unique identifier on claims for items and services, and to require providers with a department of a provider to submit to the Centers for Medicare & Medicaid Services an attestation with respect to each such department.