Feds to review facility fees, pricing notifications following patient complaints

Rising consumer complaints over unexpected provider-based billing charges for episodes of care have spurred federal regulators to examine the procedures in place for hospital service charges and pricing transparency, reports The Plain Dealer.  

Provider-based billing allows a healthcare organization to bill patients for physician care in addition to a service charge for the patient's use of hospital facilities and equipment. In some cases, a patient may be responsible for the service bill if their insurance declines to pay or if the patient has a high deductible health plan.  

Several complaints about the billing practice have surfaced against Cleveland Clinic this year, according to the report.

Cleveland Clinic spokeswoman Heather Phillips said Medicare beneficiaries are notified of the service charge each time they receive care at the hospital, in compliance with federal law, and privately insured patients are notified once a year, according to the report.

Federal regulators, concerned with rising care costs and consumer complaints, plan to review the impacts of provider-based billing this year.

Under HHS' Office of Inspector General fiscal year 2016 work plan, the federal organization plans to examine whether government regulators are adequately enforcing rules that require Medicare beneficiaries to be notified of hospital service charges prior to receiving care. 

Last year, President Barack Obama signed legislation outlawing provider-based billing at off-campus outpatient facilities, however the law does not apply to existing outpatient centers.

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