{"id":693,"date":"2020-01-30T15:14:20","date_gmt":"2020-01-30T19:14:20","guid":{"rendered":"http:\/\/blogs.duanemorris.com\/healthlaw\/?p=693"},"modified":"2020-01-30T15:15:54","modified_gmt":"2020-01-30T19:15:54","slug":"congress-investigates-surprise-billing-for-out-of-network-doctors-at-in-network-facilities","status":"publish","type":"post","link":"https:\/\/blogs.duanemorris.com\/healthlaw\/2020\/01\/30\/congress-investigates-surprise-billing-for-out-of-network-doctors-at-in-network-facilities\/","title":{"rendered":"Congress Investigates \u201cSurprise Billing\u201d for Out-of-Network Doctors at In-Network Facilities"},"content":{"rendered":"

By Ryan Wesley Brown<\/a><\/p>\n

In December, several members of the House and Senate expanded a bipartisan investigation into what is commonly referred to as \u201csurprise billing.\u201d Their investigation focuses on the practice of billing patients for medical services when patients receive care by out-of-network<\/strong> physicians at an in-network<\/strong> facility. The legislators sent letters to several of the largest insurers and physician staffing companies in order to gather more information about this practice.<\/p>\n

In these letters, legislators sought further information about the reasons for surprise bills as well as \u201cthe current incentives behind the negotiations between providers and insurers.\u201d The letters focus particularly on those services that are \u201coutsourced\u201d by hospitals to physician staffing companies. Generally, these physician staffing companies and hospitals will have negotiated separately with insurers, resulting in a discrepancy between insurance coverage for the facility versus the provider.<\/p>\n

These letters follow earlier efforts by legislators to investigate private equity firms with ownership interests in physician staffing and emergency transportation companies.<\/p>\n

At the time of this investigation, several states have implemented laws to prohibit or regulate this practice, and congressional debate on the topic is ongoing. The bipartisan support for these investigations suggests that there is some momentum in Congress for passing federal legislation, but it is not yet clear what form that will take and where partisan lines may be drawn.<\/p>\n

Federal legislation in this area may ultimately regulate ERISA plans. This is significant because state laws are generally preempted by ERISA with respect to surprise billing and only some states have allowed ERISA plans to \u201copt in\u201d to their surprise billing schemes.<\/p>\n

We will continue to closely follow these developments at the federal level along with our ongoing analysis of state-level efforts to regulate surprise billing practices.<\/p>\n","protected":false},"excerpt":{"rendered":"

By Ryan Wesley Brown In December, several members of the House and Senate expanded a bipartisan investigation into what is commonly referred to as \u201csurprise billing.\u201d Their investigation focuses on the practice of billing patients for medical services when patients receive care by out-of-network physicians at an in-network facility. The legislators sent letters to several … <\/p>\n

Continue reading “Congress Investigates \u201cSurprise Billing\u201d for Out-of-Network Doctors at In-Network Facilities”<\/span><\/a><\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[199,856,672,202,855,828],"ppma_author":[906],"class_list":["post-693","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-billing","tag-congress","tag-insurers","tag-providers","tag-ryan-wesley-brown","tag-surprise-billing"],"authors":[{"term_id":906,"user_id":6,"is_guest":0,"slug":"duanemorris3","display_name":"Duane Morris","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/843ff6e7a8fe5fc92109b47a45f34b6cf0ea499e6e788db23456c838b0ae6747?s=96&d=blank&r=g","author_category":"1","last_name":"Sullivan","first_name":"Margaret","job_title":"","user_url":"http:\/\/www.duanemorris.com","description":"Visit the Duane Morris website.<\/a>"}],"_links":{"self":[{"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/posts\/693","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/comments?post=693"}],"version-history":[{"count":0,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/posts\/693\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/media?parent=693"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/categories?post=693"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/tags?post=693"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/blogs.duanemorris.com\/healthlaw\/wp-json\/wp\/v2\/ppma_author?post=693"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}