CMS' surprise-billing rule outlaws retroactive ED denial policies

CMS' proposed surprise-billing rule prohibits insurers from retroactively denying emergency department claims. 

The ban is buried in CMS' 411-page rule, which was unveiled July 2, and is the first in a series of rules aimed at shielding patients from surprise billing. The interim final rule addresses several provisions in the No Surprises Act passed by Congress last year.

CMS said in the rule that it is aware that some plans currently deny coverage provided in hospital EDs if the claim is considered nonemergent based "soley on final diagnostic codes."

CMS said the practice is "inconsistent with the emergency services requirements of the No Surprises Act and the ACA."

The move came after UnitedHealthcare delayed its policy that could have led to retroactive denials for ER claims. The policy was set to take effect July 1, but UnitedHealthcare said June 10 that "based on feedback from our provider partners and discussions with medical societies, we have decided to delay the implementation of our emergency department policy until at least the end of the national public health emergency period."

Read more about the final rule here

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