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Final Rule Implements Ban on Surprise Billing Medical Billing

Final Rule Implements Ban on Surprise Medical Billing

August 26, 2022

On Aug. 19, 2022, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) jointly released a final rule implementing the ban on surprise medical billing under the No Surprises Act (NSA), which was enacted as part of the Consolidated Appropriations Act, 2021 (CAA). This rule finalizes two interim final rules released in July 2021 and September 2021, with certain changes related to the independent dispute resolution (IDR) process that has been the subject of ongoing litigation.

 

The Departments also released FAQs on NSA implementation in conjunction with the final rule that provide more detail on the surprise medical billing ban.

Surprise Medical Bills

Surprise medical bills occur when patients unexpectedly receive care from out-of-network providers (for example, treatment at an in-network hospital involving an out-of-network doctor). Patients often cannot determine the network status of providers during treatment to avoid additional charges and, in many cases, are not involved in the choice of provider at all.

Overview of the Final Rules

The final rule is generally intended to make certain medical claims payment processes more transparent and clarify the process for providers and health insurers to resolve their disputes. It:

  • Implements certain disclosure requirements related to information that group health plans and health insurance issuers offering group or individual health coverage must share about the qualifying payment amount (QPA) (generally, the health plan’s median contract rate for the item or service in the geographic area);
  • Finalizes certain changes related to the federal independent dispute review (IDR) process in light of ongoing litigation; and
  • Requires plans and issuers to disclose additional information in situations where they change a healthcare provider’s billing code to one of lesser value (lowering the payment to the healthcare provider).

Important Dates

July 1, 2021, and Sept. 30, 2021

Interim final rules to implement provisions of the No Surprise Act (NSA) related to surprise billing were released.

 

Aug. 19, 2022

Rules implementing the ban on surprise billing are finalized.

 

 Jan. 1, 2022

The No Surprise Act (NSA) generally applies to plan or policy yers beginning on or after Jan. 1, 2022.

The final rules generally require healthcare providers to agree with health plans and issuers on a payment amount instead of billing patients for unpaid balances.

For a copy of this overview, click below:

Final Rule Implements Ban on Surprise Medical Billing

 

If you have any questions on this or other benefits-related legislation, please contact us at 714.716.4060 or mike@my-EBP.com, or provide info here .

While every effort has been taken in compiling this information to ensure that its contents are totally accurate, neither the publisher nor if different, the author can accept liability for any inaccuracies or changed circumstances of any information herein or for the consequences of any reliance placed upon it.

This publication is posted on the understanding that the publisher is not engaged in rendering legal, accounting, or other professional advice or services. Readers should always seek professional advice before entering into any commitments.

Tax time-Important employees are educated on the new W-4

Tax time – It’s important employees are educated on the new W-4

March 6, 2020

With all the rushing around to complete their taxes, employees may not be aware of the new W-4 form which could affect their taxes, if not this year, potentially next year.

Employees becoming more educated on the new W-4 form will provide another way to help ensure that they get the most out of their taxes. The new form eliminates the “personal exemption” component of calculating taxes for the employee and instead, calculates taxes based on answers to a few personal questions. Only new employees in 2020 will be required to fill out the redesigned form, which was released in early December 2019. Even though current employees are not required to fill out the new form, the new tax calculations could change whether or not they owe taxes when they file in 2021, depending on whether their withholding status changes.

IRS has pointed out that because of the tax reform law in 2018, last year there were people who owed money and weren’t expecting that – not completing the new W-4 could potentially create the same situation for these employees again during the next tax season. Even though the IRS has stated that the new W-4 form is more streamlined, many employees and their employer are not sure how to interpret the changes. Employees are encouraged to consult their legal tax adviser to check on how it affects their individual tax situation.

Essentially, the IRS has said that the new form will make it easier for employees to adjust their wages and claim qualifying tax credits to get a more accurate determination of their income tax withholding. With some tax experts, the jury is still out on if this will actually be the case. Payroll industry experts were consulted by the IRS when designing the new W-4 to make it as easy to understand as possible. There are a few things employers should know about the new form in order to better communicate its benefits to their employees.

First, the whole idea of personal exemptions was suspended which potentially increases the child tax credit and makes it available for more people. In addition, the standard deduction was greatly increased for everybody, which could mean that more people are going to take it instead of itemizing.

Every taxpayer who claims a child dependent will receive a maximum tax credit of $2,000 per child under the new form. The previous W-4 form calculated taxes based on the number of allowances claimed, so employees who don’t file a new W-4 may not receive the full benefit of the updated tax credit if they qualify. The IRS recommends that employees check with their legal tax adviser for assistance on checking on their withholdings every year.

In early 2020, the IRS launched its upgraded Tax Withholding Estimator , a calculator to help employees determine how much to withhold from their taxes. The tool addresses issues like changes in income, withholding status and multiple jobs. The calculator provides information to help employees fill out the new W-4. Employers are encouraged to share this information regarding the new W-4 form and the tax calculator tool above with their employees.

Having your employees understand the forms they are required to fill out & making it easy to fill them out & make changes periodically is important not only during the on-boarding stage but throughout their employment. It will ultimately reinforce their decision and confidence that made you their employer of choice. We work with our clients to incorporate this. Let’s start a conversation today to solidify this type of confidence with your employees.

While every effort has been taken in compiling this information to ensure that its contents are totally accurate, neither the publisher nor if different, the author can accept liability for any inaccuracies or changed circumstances of any information herein or for the consequences of any reliance placed upon it.

This publication is posted on the understanding that the publisher is not engaged in rendering legal, accounting, or other professional advice or services. Readers should always seek professional advice before entering into any commitments.

Tip #2 Employees Ask – How do I choose between the ER and Urgent Care?

Tip #2 Employees Ask – How do I choose between the ER and Urgent Care?

February 21, 2020

Enrolling in a medical plan is one thing. Understanding your plan is another. Educating your employees to become smarter about their healthcare can translate into healthier employees and cost savings.

Another common area of confusion involves employees choosing between the Emergency Room (ER) and the local Urgent Care. Here is a common employee scenario:

From wobbly ladders, dull kitchen knives, to our kids sports teams, most of us will find ourselves in a mishap that creates a medical emergency requiring instant help and care. When the unexpected happens, it’s important to know whether to choose the ER or an urgent care center. If your are wondering what the differences are between the two, you are not alone.

Both will allow you to walk in without an appointment. Both can address health problems within hours, or even minutes. However, going to the ER versus going to urgent care can make a big difference when it comes to getting the most out of your insurance plan. After all, even though emergency rooms and urgent care centers have some similarities, they do not have the same pricing schedules or wait times. To understand why, let’s start off with some basic definitions.

TERMS TO KNOW

  • Emergency Room: Usually an attached department of a hospital, the emergency room is designed to treat walk-in visitors with life-threatening conditions, trauma, severe injuries, and sudden serious illnesses.
  • Urgent Care: An urgent care center also takes walk-in visitors and can treat many of the same illnesses, injuries, and health problems as an ER. However, it has a limited ability to treat certain conditions and is better for minor health issues – not life-threatening healthcare situations or conditions that may require an operation or more complex diagnostic tests like an MRI or CAT scan.
  • Walk-In Clinics: Often found within or near local retailers and pharmacies, these clinics are best suited for handling minor conditions such as colds, flu, minor cuts, immunizations, or health screenings.

WHAT TO CONSIDER

Knowing the difference between each of these terms can have a real impact on your wallet and your experience of receiving care. While an ER could treat any of the urgent care issues, it is must be noted that emergency rooms are busier and more expensive. The average ER costs $1,500 to $1,900 per visit while the average urgent care visit costs patients $50-$125 for basic care, with additional costs added for things like shots, x-rays (if available) and labs.

On the flip side, it is important to note that urgent care centers may not be able to treat the serious illnesses or conditions reserved for emergency rooms. That said, of the top diagnosis at both urgent care centers and ER’s, nearly 50% of them are the same. Both emergency rooms and urgent care centers are staffed with compassionate health care providers and in most cases both facilities will have doctors and nurses available. Both ER and urgent care centers are able to give patients shots, medications, IV’s and even treatment plans. Also, many urgent care centers offer x-rays, just like emergency rooms.

UNDERSTAND YOUR BEST OPTION

In the end, save ER visits for critical health trauma or accidents, such as heart attacks or chest pain, strokes, difficulty breathing, uncontrollable bleeding, severe pain or fever, loss of consciousness, and other dangerous life-threatening illnesses. Emergency rooms are prepared to respond to almost any serious emergency and have the needed equipment, for instance, radiology labs, CAT scanners, MRI’s and operating rooms. While urgent care centers have some medical equipment, they simply are not equipped like an emergency room for severe medical needs.

If you need minor health services, opt for the urgent care. Not only will you reduce your bill, you will usually spend much less time. Urgent care centers are ideal for non-critical stitches, non-life threatening x-rays, allergy, cold, and flu treatment and preventive care.

BE PREPARED UPFRONT

The first step toward saving is preparing. Proactively research the best in-network urgent care centers and ER’s for your local area by calling your health plan’s customer service center upfront before the need for healthcare, whether serious or minor, arises. For urgent care centers, pay attention to the stated hours. While some urgent care centers are open 24/7, others close at night or have limited “after-hour” times. If you are travelling, find a list of medical centers, ER or urgent care centers, along your route that accept your insurance.

CONCLUSION

Having your employees understand their health plan is important so that they truly value the benefit and can feel confident they are getting the most out of their plan. The experienced team at MY-Employee Benefits Plus is here to help. We work with our clients to put in place effective and repeatable employee benefit plan education. Let’s start a conversation that will lead your employees to know, like, understand and ultimately have positive, valued experience with their employee benefits.

While every effort has been taken in compiling this information to ensure that its contents are totally accurate, neither the publisher nor if different, the author can accept liability for any inaccuracies or changed circumstances of any information herein or for the consequences of any reliance placed upon it.

This publication is posted on the understanding that the publisher is not engaged in rendering legal, accounting, or other professional advice or services. Readers should always seek professional advice before entering into any commitments.