The House Education & Workforce Committee advanced four bills July 12 that look to strengthen healthcare price transparency.
One of the bills, H.R.4509, would require off-campus hospital outpatient departments to obtain a separate unique health identifier and include it on all claims for services billed to commercial health plans or their enrollees, according to a July 12 post on the American Hospital Association's website. The legislation would prohibit health plans from paying a claim and the hospital from collecting payment if the claim excludes the identifier. It would also impose fines on hospitals that violate the requirement.
AHA Executive Vice President Stacey Hughes said in the post that the AHA stands ready to work with policymakers to make the healthcare system more accessible and fair for patients, but "this work is too important to be distracted by misinformation and inaccuracies on the intent and practices of hospitals."
"Hospitals and health systems bill according to federal regulations, which require them to bill all payers using codes that indicate the location of where the service is provided," she said in the post. "All hospital outpatient departments bill using a code that identifies them as a hospital outpatient department, regardless of location. This is not 'dishonest billing' — it is simply following current payment policies that take into account fundamental differences between hospital outpatient departments and other outpatient care settings."
Ms. Hughes added that the scrutiny over physician office acquisitions wrongly focuses on hospitals as the primary drivers of the practice. She said that over the past five years, private equity firms and commercial insurers like UnitedHealthcare and Humana are responsible for the overwhelming majority of physician acquisitions.
The other bills that passed the committee are:
- H.R. 4507, which would strengthen price transparency requirements for commercial health plans.
- H.R. 4527, which would require that the health plans' contracts with service providers allow the employer/plan fiduciary to access all de-identified claims and encounter data.
- H.R. 4508, which would require plans to further report to the employer/fiduciary their financial arrangements with PBMs.