HHS lays out surprise billing resolution process in new rule

Transformation Hub Where healthcare challenges find solutions Patients Operations Care Delivery Payment Modern Healthcare Illustration / Getty Images

The Biden administration on Thursday laid out the independent dispute resolution process that out-of-network providers and plans can use to settle surprise billing disputes.

The long-awaited rule implements a law passed by Congress last year banning providers from sending surprise bills to patients who unknowingly received out-of-network care.

Providers, facilities, plans and issuers can use the independent dispute resolution process if a payment amount for out-of-network services can not be agreed upon after a 30 day “open negotiation,” according to the interim final rule issued Thursday.

The rule “takes consumers out of the middle of a payment dispute between insurers and providers,” an HHS official told reporters Thursday.

Beginning Thursday, organizations can apply to become certified independent dispute resolution entities.

Story developing… Tags: Payment, This Week in Healthcare, Legislation & Regulation, Payment, Transformation, Transformation Hub, Insurers