Enacts provisions relating to payment for health care services
The enactment of SB 986 will significantly impact the way healthcare billing is conducted in Missouri. By requiring unique NPIs for different service locations within the healthcare system, the bill addresses the existing issues of billing confusion and potential overcharging related to outpatient services. Furthermore, it imposes strict requirements for health carriers, making them liable only for claims that comply with these billing practices. This could lead to a more transparent billing process, benefiting patients by ensuring they are only billed for services rendered appropriately.
Senate Bill 986, known as the 'Honest Billing Act,' aims to amend laws regarding payment for healthcare services in Missouri, particularly focusing on claims submitted for services provided at off-campus outpatient departments. Scheduled to take effect for claims submitted after January 1, 2025, the bill establishes that these departments must use a unique National Provider Identifier (NPI) distinct from that of the main hospital campus. This requirement is expected to improve the specificity and accuracy of billing for health services, reducing confusion for both patients and insurers.
Despite its intended benefits, SB 986 has drawn discussion regarding the potential challenges it may impose on healthcare facilities. Some stakeholders, particularly smaller practices, have expressed concerns about the operational burdens associated with implementing the new billing process and ensuring compliance with the distinct NPI requirement. Moreover, there are apprehensions about the administrative penalties that may be imposed for non-compliance, which include fines and potential loss of licenses, raising fears about the sustainability of smaller providers who may struggle to adapt to these new regulations.