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Congress Revisits Surprise Billing With New Mediation Proposal

February 07, 2020

The latest attempt to reach resolution on the controversial practice of surprise billing comes from the House Ways & Means Committee, who propose a two-step mediation process to resolve disputes and eliminate the problem.

The bipartisan Consumer Protection Against Surprise Bills Act of 2020 submitted by Committee Chairman Richard E Neal (D-MA) and Ranking Member Kevin Brady (R-TX) “puts patients first by protecting the patient from balance bills, enhancing consumer protections, requiring greater transparency, and empowering patients with information about their health care costs,” according to The Ways and Means press release.

Leading up to this legislation, payers and providers have been conflicted with how to resolve surprise billing disputes. A significant debate pinning linking payments to benchmark rates vs using an arbiter have been long and ongoing.*

Under the new mediated dispute resolution process, either the payer or provider has the option to open a 30-day negotiation period to resolve without federal intervention. If the dispute is not resolved within that period, either party can initiate a mediation process, conducted by a third part without any payer/provider affiliation, according to the bill summary.  

The summary continued, “During mediation, the parties will present best and final offers along with any supporting information to the mediator, who will also consider the median contracted rate specific to the plan, and for similar providers, services, and geographic areas.”

The bill also includes parameters to end surprise billing, offers new patient protections, and additional guidance for uninsured or cash-paying patients.

“Our priority throughout the painstaking process of crafting our legislation has been to get the policy right for patients, and we firmly believe that we have done that,” Chairman Neal and Ranking Member Kevin Brady (R-TX) said in a press release. “We look forward to working with our Democratic and Republican colleagues in Congress, as well as the Administration, to advance this measure swiftly.”

—Edan Stanley

*Read expert commentary on the benchmark vs arbiter dispute

Ways & Means Committee. Neal and Brady release legislative text of surprise medical billing proposal [press release]. Published February 7, 2020.




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