Becerra says unexpected billing rules are forcing doctors who charge inflated fees to accept fair prices

Overpriced doctors and other health care providers who cannot charge reasonable fees for their services may be stopped when new rules against unexpected medical bills come into force in January, which is good, HHS Secretary Xavier Becerra told KHN in defense of the rule. …

The proposed rules represent the Biden administration’s plan to implement No surprises lawwhich Congress passed to save patients from the shockingly high bills they get when one or more of their providers are unexpectedly out of their plan’s network.

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The law shields patients from these bills by requiring providers and insurers to determine how much doctors or hospitals should be paid, first through negotiation and then, if they cannot agree, in arbitration. However, groups of doctors and medical associations pounced on the temporary final regulations which HHS made public last month, stating that they prioritize insurance companies in the arbitration phase. This is because while the rules instruct arbitrators to take many factors into account, they are instructed to start with a benchmark that is largely determined by insurers: the median rate negotiated for similar services between intranet providers.

Groups of doctors say giving insurers an advantage would allow them to lower payout rates and potentially force doctors to leave networks or even stop working, limiting access to healthcare.

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The department has heard of these concerns, Becerra said, but the key is protecting patients. Healthcare providers who have used a complex system to charge exorbitant rates will have to bear their share of the cost, or shut down if they cannot, he said.

“I don’t think that when someone is reloading it will hurt the recharge, so now [accept] fair price, ”Becerra said. “Those who inflate the price either have to tighten their belts and do it better, or they won’t last in business.”

“It’s not fair to say that we have to let someone gouge us out so they can do business,” he added.

Nonetheless, Becerra said he did not anticipate waves of closures or restrictions on consumer access. Instead, he suggested that the competitive market process would find a balance, especially when consumers know better what they are paying for.

“We are ready to pay a fair price,” he said. But he stressed: “I will pay for the best, but I do not want to have to pay for the best, and then three times more, and I did not have enough bills.”

Becerra also pointed to a report on unexpected medical bills that HHS was due to release on Monday and which was provided to KHN in advance, highlighting the impact of negotiation and arbitration laws already in place in 18 states.

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A report combining previous studies found that people were unexpectedly paid an average of $ 1,219 for anesthesiologists, $ 2,633 for surgical assistants, $ 744 for childbirth, and over $ 24,000 for air ambulances.

In states that use benchmarks similar to those that doctors suggest using HHS, such as New York and New Jersey, the report sees rising costs. New York has a “baseball-style” system in which the arbiter chooses between the bids submitted by the supplier and the insurer, although the arbiter is told he should consider the proposal that comes closest to the 80th percentile of fees. “Since the amount charged by service providers tends to be much higher than the actual agreed rate, this approach could lead to a significant increase in overall costs,” the report says. In New Jersey, assessed fees or “regular and regular” rates apply.

“When the arbitration process is wide open, borderless, the end result is health care costs going up, not going down,” Becerra said of the methods doctors prefer. “We want costs to come down. And so we want to create a system that will help us serve as benchmarks to maintain our efficiency, transparency and profitability. ”

The Congressional Budget Office estimated that the system chosen by the Biden administration should have cut insurance premiums by 0.5-1%.

“Everyone has to give a little to get to a good place,” Becerra said. “I hope this is the sweet spot where patients … are pulled out of this food struggle. And if the fight for food continues, the arbitration process will help solve it in an efficient way, but it will also lead to lower costs. ”

While the administration has chosen a benchmark that doctors and hospital groups do not like, the law states that other factors should be considered, such as provider experience, market and case complexity. Becerra said these factors help ensure the fairness of the arbitration.

“We just set up a rule that says, ‘Show proof,’” Becerra said. “It has to be relevant physical evidence. And may the best win in this arbitration battle. “

The interim final rules were published on October 7, giving stakeholders 60 days to comment and amend. More than 150 members of Congressmany of them doctors, have asked HHS and other relevant federal agencies to reconsider their decision before the law goes into effect on January 1. Lawmakers say the administration does not adhere to the spirit of compromises that Congress made in passing the law.

Rules that go this far tend to go into effect with little or no change, but Becerra said his department is still listening. “If we believe that any changes need to be made, we are ready to do so,” the secretary said.

The HHS report also notes that the law requires detailed monthly and annual reports to be submitted to regulators and Congress to determine if the rules are not working or have undesirable consequences, such as those warned by doctors.

Becerra said he believes the rules strike the right balance, favoring people who need medical attention rather than insurers or doctors.

“We want it to be transparent in order to increase competition and reduce costs – not only for the payer, the insurer, not only for the healthcare provider, hospital or doctor, but especially for patients,” he said. …

Kaiser Health News is the national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation and is not affiliated with Kaiser Permanente.

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