Industry Insight

HHS Announces Rule to Protect Consumers From Surprise Medical Bills

The Biden-Harris Administration, through the US Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management (OPM), recently issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out-of-pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and nonemergency care. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans.

“No patient should forgo care for fear of surprise billing,” says HHS Secretary Xavier Becerra. “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.”

Among other provisions, the interim final rule bans the following:

• Surprise billing for emergency services. Emergency services, regardless of where they are provided, must be treated on an in-network basis without requirements for prior authorization.

• High out-of-network cost-sharing for emergency and nonemergency services. Patient cost-sharing, such as coinsurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates.

• Out-of-network charges for ancillary care (eg, an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances.

• Other out-of-network charges without advance notice. Finally, health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.

These provisions will provide patients with financial peace of mind when seeking emergency care as well as safeguard them from unknowingly accepting out-of-network care and subsequently incurring surprise billing expenses.

Ramifications for the Patient
Tackling surprise billing is critically important, as it often has devastating financial consequences for individuals and their families. Two-thirds of all bankruptcies filed in the United States are tied to medical expenses. Researchers estimate that 1 of every 6 emergency department visits and inpatient hospital stays involve care from at least one out-of-network provider, resulting in surprise medical bills. And a 2019 study by the Government Accountability Office found that the median price charged by air ambulance providers ranged from $36,400 to more than $40,000, and more than 70% of these transports were furnished out-of-network, meaning most or all costs fell to the insured individual alone. Thanks to the Biden-Harris Administration and bipartisan congressional support, HHS, Labor, Treasury, and OPM are promulgating rules that will protect consumers from financial ruin simply because they could not ask for an in-network provider during their treatment.

“No one should ever be threatened with financial ruin simply for seeking needed medical care,” says US Secretary of Labor Marty Walsh. “Today’s Interim Final Rule is a major step in implementing the bipartisan No Surprises Act that will protect Americans from exorbitant health costs for unknowingly receiving care from out-of-network providers.”

This interim final rule with request for comments implements the first of several requirements passed with bipartisan support in title I (the “No Surprises Act”) of division BB of the Consolidated Appropriations Act, 2021. The regulations will take effect for health care providers and facilities January 1, 2022. For group health plans, health insurance issuers, and Federal Employees Health Benefits Program carriers, the provisions will take effect for plan, policy, or contract years beginning on or after January 1, 2022.

Fact sheets on this interim final rule can be found here and here. The interim final rule with comment period can be accessed here.

— Source: Health and Human Services

 

Formation of Texas Health Informatics Alliance Announced

The University of Texas at Arlington (UTA), University of Texas Health Science Center at Houston (UTHealth), and the University of Texas Southwestern Medical Center announce the formation of the Texas Health Informatics Alliance (THIA) and plans for its first THIA Conference to be held virtually on September 9.

THIA is a collective that aims to build informatics ties across Texas through partnerships in the following areas: research, data, policy, education, standards, and workforce development.

“THIA will give informaticians in Texas the opportunity to collaborate, communicate, and network. Data, knowledge, and informatics will allow us to become more productive and successful in improving health care outcomes of Texans,” says Christoph U. Lehmann, MD, director of the Clinical Informatics Center at UT Southwestern, a professor of population and data sciences, and member of the THIA conference planning committee.

THIA is inviting researchers, developers, health professionals, information management professionals, data and information scientists, students, and anyone interested in health informatics to join.

The THIA conference will provide an opportunity to share, collaborate, and showcase the amazing work in health informatics and will feature presentations and keynote speakers from across Texas. The theme will be “All In: Informatics Lessons from the Pandemic to Reimagine Health Care.”

This virtual conference will be held from 9 AM to 4 PM CST on Thursday, September 9. Complimentary registration is available through the THIA 2021 website.

“Over the past few years, health care informatics has developed from a siloed disciplinary interest to a multi-interdisciplinary focus, embracing all health-related disciplines from consumer, provider, payer, and the health care industry. We now need to focus on developing and disseminating knowledge in this new era of interprofessional and interdisciplinary collaboration. This is of great importance,” says Marion J. Ball, EdD, a professor and executive director of the Multi-Interprofessional Center for Health Informatics at UTA and a conference planning committee member.

The conference will feature two keynote speakers, a panel presentation, four plenaries, and four student presentations. The keynote speakers are Peter J. Hotez, MD, PhD, dean of the National School of Tropical Medicine and a professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine, and Nora Belcher, executive director of the Texas e-Health Alliance, a nonprofit that advocates for the use of information technology to improve the health care system. Panelists for the afternoon session are Katherine Lusk, MHSM, RHIA, FAHIMA, president/chair of AHIMA; Dean F. Sittig, PhD, a professor in the School of Biomedical Informatics at UTHealth; William M. Tierney, MD, a professor of population health, internal medicine, and oncology at Dell Medical School, UT Austin; and Ferdinand Velasco, MD, FHIMSS, senior vice president/chief health information officer of Texas Health Resources.

“We hope that the THIA and our first conference will contribute to the greater use of informatics in health care in our region, as well as promote research and education in the field,” says Gabriela Mustata Wilson, PhD, a professor and codirector of the Multi-Interprofessional Center for Health Informatics at UTA. “By joining THIA and participating in the annual conference, you will be able to collaborate and connect in Texas’ health informatics community to improve health care and meet our state’s current and future health informatics needs.”

The THIA invites researchers, developers, health professionals, information management professionals, data and information scientists, and students to submit abstracts for presentations describing the use of data and information technology to combat pandemic outbreaks in the community, hospitals, practices, and academic medical centers. The conference’s focus will be on COVID-19, but contributions addressing other outbreaks (eg, Zika, MERS, SARS, tuberculosis, West Nile) are also welcome. Abstract submission details are available on the website.

Susan H. Fenton, PhD, an associate professor and associate dean at UTHealth School of Biomedical Informatics and a member of the conference planning committee, says: “The effective use of data and information to support health has never been more important. This new informatics alliance promotes collaboration, innovation, and improved health across the state of Texas and beyond.”

— Source: UT Southwestern Medical Center

 

JTS Introduces New Director of Client Services & Privacy Officer

JTS Health Partners (JTS) announces the addition of Michelle Darby, CHC, RHIA, as director of client services and privacy officer. In this role, Darby will manage the revenue cycle and HIM operations, as well as serving as privacy officer.

“We are very excited to have Michelle join the JTS team. After witnessing her talent, work ethic, and professionalism, we were anxious to bring her on board. Michelle’s dedication to accuracy and rapport with clients are exemplary,” says Thomas Stewart, president and cofounder of JTS Health Partners.

Darby has more than 20 years of diverse and extensive HIM, corporate compliance, and privacy and security–related experience in both tertiary and behavioral health care settings. As well as being thoroughly versed in health care revenue cycle operations and management, inclusive of billing and coding processes, she possesses thorough knowledge and understanding of health care operations and management and has a solid foundation of managerial and leadership experience. Additionally, she has proven experience in privacy education, regulatory compliance, and privacy program management.

Darby has served as a senior consultant to multiple health care organizations leading management staff and diverse teams of administrative professionals in executing new processes and procedures, system implementations (including, training, testing, policy and procedure revisions, modifications, development and rollout) and adaptions to industry mandates. Previously, she was director of HIM at Northside Hospital-Gwinnett Medical Center, where she was responsible for the management of all health information and medical records functions throughout the organization.

“JTS’s culture and environment offer an excellent opportunity to utilize my skills while providing exceptional service to our clients and leadership to our team. Being part of a team that helps clients achieve financial and operational success is very rewarding,” Darby says.

— Source: JTS Health Partners

 

Donovan Named PHIMA President

Stephanie Donovan, EdD, MBA, RHIA, faculty chair for health care and human services leadership programs at Peirce College, has become the president of the Pennsylvania Health Information Management Association (PHIMA) Board of Directors.

“We are honored that Dr. Donovan will serve as our new president,” says PHIMA Executive Director Linda McLinden, RHIA. “Her background as both a practitioner and educator will help us advance our mission to empower people to impact health in a world where trusted information transforms health and health care by connecting people, systems, and ideas.”

Founded in 1938, PHIMA is a nonprofit organization that supports more than 3,000 HIM professionals and students throughout Pennsylvania. It is one of the largest state associations in the country within AHIMA.

Donovan, a resident of Doylestown, Pennsylvania, has worked in the outpatient setting and has held leadership positions at the local, state, and national levels of AHIMA, including serving as State Advocacy Coordinator for PHIMA, and as an appointed member of the AHIMA Council for Excellence in Education. She currently serves on Albert Einstein’s Institutional Review Board as a secondary reviewer for research involving human subjects.

“We are extremely proud of Dr. Donovan and her appointment as president of the PHIMA Board of Directors,” says Rita Toliver-Roberts, EdD, provost and vice president of academic affairs at Peirce College. “She is a critical part of the Peirce community and will be a tremendous resource to the members of PHIMA.”

“I am honored and excited to serve as president of the PHIMA Board of Directors and help support our members,” Donovan says. “Health information management plays a critical role in the quality and security of our nation’s health care system and presents great career opportunities for the residents of Pennsylvania and the region. I look forward to continuing my work with my colleagues at PHIMA to support our mission.”

— Source: Peirce College