The House Education & Workforce Committee July 12 voted 39-0 to pass legislation (H.R. 4509) that would require off-campus hospital outpatient departments to obtain a separate unique health identifier and include it on all claims for services billed to commercial group health plans or their enrollees. The legislation would prohibit the health plan from paying the claim and the hospital from collecting payment from the plan enrollee if the claim excludes the identifier, and impose civil monetary penalties on hospitals that violate the requirement.
In a statement, AHA Executive Vice President Stacey Hughes said, “The AHA is committed to strengthening the U.S. health care system and we appreciate the Committee on Education and the Workforce’s interest in achieving this goal. We stand ready to work with policymakers to make our health care system more accessible and fairer for patients.
“That said, this work is too important to be distracted by misinformation and inaccuracies on the intent and practices of hospitals. Hospitals and health systems bill according to federal regulations, which require them to bill all payers using codes that indicate the location of where the service is provided. All hospital outpatient departments bill using a code that identifies them as a hospital outpatient department, regardless of location. This is not ‘dishonest billing’ — it is simply following current payment policies that take into account fundamental differences between hospital outpatient departments and other outpatient care settings.
“Additionally, the scrutiny over acquisitions of physician offices wrongly focuses on hospitals as the primary drivers of this practice. The fact is, over the last five years, entities like private equity firms and commercial insurers, including UnitedHealthcare and Humana, are responsible for the overwhelming majority of physician acquisitions. Together, they are behind a whopping 75% of all acquisitions while hospitals and health systems only account for 6%. These numbers leave no room for confusion on who should be the focus of the committee’s investigation into this and its impacts to patients and consumers.”
In other action, the committee also passed bills that would strengthen price transparency requirements for commercial group health plans (H.R. 4507); require that the plans’ contracts with service providers allow the employer/plan fiduciary to access all de-identified claims and encounter data (H.R. 4527); and require the plans to further report to the employer/fiduciary their financial arrangements with pharmacy benefit managers (H.R. 4508).