FAIR Health outlines potential solutions to surprise billing problem

FAIR Health, a national nonprofit focused on healthcare cost transparency, released a brief March 6 on the surprise billing debate to offer potential reimbursement solutions.

Federal lawmakers, providers, insurers, employers and consumer groups are all working together to reach consensus on the issue. Many states are also considering surprise billing issues.

Nearly all stakeholders agree that patients need to be protected from surprise bills involving unintended out-of-network services, including emergency services, FAIR Health said. However, a key issue in the debate is how to determine the amounts that health plans should pay to compensate providers for care rendered.

The organization outlined various potential reimbursement formulations — such as percentiles of billed charges, formulations based on allowed or negotiated amounts, a hybrid embodying both billed and allowed values, and a multiple of Medicare — which could be used to determine the amounts health plans should pay providers.

Another option for policymakers would be to implement a dispute resolution process between health plans and providers, with or without guidelines.

"The policy 'onion' gets peeled even further as parties consider whether, if independent dispute resolution is selected, should there be a guidepost for resolving the dispute [such as the New York law which uses FAIR Health's 80th percentile of billed charges as a guide for discussions, among other factors] or should it be a straight baseball arbitration format without any articulated standard," said Robin Gelburd, FAIR Health's president.

"Each state has its own particular interests to protect and constituents to recognize. Accordingly, it has been a fascinating legislative 'laboratory' to observe," Ms. Gelburd said.

Read FAIR Health's full brief here.  


More articles on healthcare finance: 

Oregon proposes minimum for hospitals' community benefit spending
Patients more likely to ditch preferred hospital after a surprise bill, study finds
Patients will shop around for lower-priced providers if rewarded, study finds

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