HHS Report Calls for Congressional Action to Combat Surprise Billing

From HHS.gov on July 29, 2020

HHS Secretary’s Report Calls for Congressional Action to Combat Surprise Billing and Promote Price Transparency

Today, the U.S. Department of Health and Human Services released the HHS Secretary’s Report on Addressing Surprise Billing. The report, called for in Section 7 of President Trump’s Executive Order 13877, Improving Price and Quality Transparency in American Healthcare to Put Patients First, outlines critical steps, including Congressional action, to implement the Administration’s principles on surprise billing. Sound surprise billing legislation will not only protect patients but will encourage a fairer, more transparent, patient-centered healthcare system that benefits all Americans.

“Americans have the right to know what a healthcare service is going to cost before they receive it,” said HHS Secretary Alex Azar. “President Trump and his administration have done their part to deliver historic transparency around the prices of many procedures. Now it’s time for Congress to do what we all agree is necessary: combat surprise billing with an approach that puts patients in control and benefits all Americans.”

Surprise medical billing is a widespread and costly problem in the United States, and the need to address it has been highlighted during the Public Health Emergency (PHE) presented by COVID-19. Research shows that 41 percent of insured adults nationwide were surprised by a medical bill in the past two years alone, and that two thirds of adults worry about their ability to afford an unexpected medical bill.  At a time when Americans are increasingly seeking medical care, practices such as surprise billing leave many patients vulnerable to the financial burdens presented by a nationwide pandemic.

HHS has taken regulatory and administrative action to increase price transparency permanently. On June 24, 2019, President Trump signed Executive Order 13877. Following direction from this Executive Order, HHS published two rules supporting the Administration’s mission to improve accessibility of healthcare price information to help patients make informed decisions about their use of healthcare services. The first, poised to go into effect January 1, 2021, requires hospitals operating in the United States to establish, update, and make public, at least annually, a list of their standard charges for the items and services that they provide. The second companion proposed rule would demand similar transparency from most group health plans and issuers of health insurance coverage within both the individual and group markets.

To supplement this progress, Congress must take additional action to build on the achievements of the Administration to eliminate the threat of surprise billing once and for all. This should be accomplished with the following principles in mind, as laid out by the Trump Administration on May 9th, 2019:

  • Patients receiving emergency care should not be forced to shoulder extra costs billed by a care provider but not covered by their insurer;
  • Patients receiving scheduled care should have information about whether providers are in or out of their network and what costs they may face;
  • Patients should not receive surprise bills from out-of-network providers they did not choose; and
  • Federal healthcare expenditures should not increase.

If done swiftly, a remarkable burden will be lifted from the shoulders of millions of Americans. By building on the foundation placed by Executive Order 13877, there is an opportunity to fill the remaining gaps and solve comprehensively a longstanding flaw, equivalent to price-gouging, within our healthcare industry.

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HHS | Post-Payment Notice of Reporting Requirements

From HHS on July 20, 2020

General and Targeted Distribution Post-Payment Notice of Reporting Requirements

July 20, 2020

Purpose

The purpose of this notice is to inform Provider Relief Fund (PRF) recipients that received one or more payments exceeding $10,000 in the aggregate from the PRF of the timing of future reporting requirements. Detailed instructions regarding these reports will be released by August 17, 2020.

Overview

Congress appropriated funding to reimburse eligible health care providers for health care related expenses or lost revenues attributable to coronavirus. The Health Resources and Services Administration (HRSA) is administering the distribution of payments under the PRF program, funded through appropriations in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136) and the Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139). Each recipient of a payment from the PRF that used any part of that payment agreed to a set of Terms and Conditions (T&Cs) which, among other obligations, require each recipient to submit reports to the Department of Health and Human Services (HHS). The reports shall be in such form, with such content, as specified by the Secretary of HHS in future program instructions directed to all recipients. HHS will be releasing detailed reporting instructions by August 17, 2020.

These reporting instructions will provide directions on reporting obligations applicable to any provider that received a payment from the following CARES Act/PRF distributions:

General Distributions:
  • Initial Medicare Distribution
  • Additional Medicare Distribution
  •  Medicaid, Dental & CHIP Distribution
Targeted Distributions:
  • High Impact Area Distribution
  •  Rural Distribution
  •  Skilled Nursing Facilities Distribution
  •  Indian Health Service Distribution
  •  Safety Net Hospital Distribution

The reports will allow providers to demonstrate compliance with the T&Cs, including use of funds for allowable purposes, for each PRF payment. HRSA plans to provide recipients with Question and Answer (Q&A) Sessions via Webinar in advance of the submission deadline. Additional details will follow regarding the Q&A Sessions.

Notice on Timing of Reports

The reporting system will become available to recipients for reporting on October 1, 2020.

  • All recipients must report within 45 days of the end of calendar year 2020 on their expenditures through the period ending December 31, 2020.
  •  Recipients who have expended funds in full prior to December 31, 2020 may submit a single final report at any time during the window that begins October 1, 2020, but no later than February 15, 2021.
  •  Recipients with funds unexpended after December 31, 2020, must submit a second and final report no later than July 31, 2021.
  •  Detailed PRF reporting instructions and a data collection template with the necessary data elements will be available through the HRSA website by August 17, 2020.

 

New Benefit | Credit Card Fee Class Action Settlement

Dear AAA Members:

As you may know, there is a class action lawsuit pending in the U.S. alleging Visa, MasterCard and their member banks engaged in anticompetitive practices. The case, Payment Card Interchange Fee Settlement, alleges activity that includes collusion which artificially inflated the interchange fee that all AAA members paid to accept Visa and MasterCard branded credit cards. The proposed settlement provides that any merchant that accepted Visa and MasterCard credit cards at any time between January 1, 2004 and January 25, 2019 will be entitled to participate in the $5.54 billion-dollar settlement

Sign Up Now

Class Action Refund has over 17 years of experience in managing complex claims and is an innovator of a niche service that specializes in the recovery of antitrust settlements for businesses, which includes large organizations like the AAA. Class Action Refund can ease the burden of self-filing. The life cycle of a claim can take several years to settle and may require various types of documentation and correspondence with the claims administrator in order to substantiate the claim. Class Action Refund will manage the entire filing process and inform you of milestones as necessary, so that you may stay focused on your core business. Additionally, there are NO OUT-OF-POCKET COSTS TO AAA MEMBERS. Class Action Refund will reduce its normal 33% contingency fee of funds recovered to 25% for AAA members.  If no recovery is made, then no fee is charged.

Any member interested in availing themselves of Class Action Refund’s recovery management services, for the Payment Card Interchange Fee Settlement can quickly and easily sign up below!

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Mr. Hugh Bellingreri, Senior Account Manager, is the contact person for members. Please call Hugh directly at 914-630-5116, or you can reach him by email at hbellingreri@classactionrefund.com with any questions. 

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Disclaimer: No claim forms are available at this time, and no claim-filing deadline exists. No-cost assistance will be available from the Class Administrator and Class Counsel during any claims-filing period. No one is required to sign up with any third-party service in order to participate in any settlement. For additional information regarding the status of the litigation, interested persons may visit www.paymentcardsettlement.com, the Court-approved website for this case.

Colorado Natural Hazards Center Grants

The Colorado Natural Hazards Center is offering three grants of $4000 for original research.

  • 1) Communications, the Pandemic, and Local Transportation Resources: What strategies are being implemented, and how effective are they? What are best practices in communicating and messaging by transportation organizations?
  • 2) Transportation, Vulnerable Populations, and COVID-19: What are best practices in providing useful and safe transportation for various socially and economically vulnerable population groups that are traditionally heavily reliant on public transit such as low-income people and racial and ethnic minorities? What about newly vulnerable populations, such as seniors, transportation workers, bus drivers, and so forth? How can the needs of all be met while assuring health and safety among particularly medically fragile or economically marginalized people?
  • 3) Transportation and Emergency Management Policy: How should transportation leaders and emergency managers work together to deliver community services? Including but also beyond ESF-1, what are innovative ways and best practices within and among communities and transportation services to accomplish community objectives during the pandemic? For example: transit agencies have launched food delivery services for vulnerable populations using their idled vehicles and drivers; state DOT facilities have been used a COVID-19 testing sites; Wi-Fi equipped vehicles have been used as local community hot spots.

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For-profit providers have to pay taxes on COVID-19 relief grants

From Modern Healthcare on July 13, 2020

The IRS clarified that for-profit healthcare providers will have to pay taxes on the grants they received from the COVID-19 Provider Relief Fund.

The two laws that set aside $175 billion in grants to help providers cover lost revenue and coronavirus-related expenses didn’t explicitly state that the funds would be taxable. However, the IRS issued guidance stating that the grants are taxable income days before a tax filing deadline on July 15. The change means that grants to for-profit healthcare providers including hospitals and independent physician practices will be subject to the 21% corporate tax rate.

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Covid-19 Is Bankrupting American Companies at a Relentless Pace

From Bloomberg on July 9, 2020.

Retailers, airlines, restaurants. But also sports leagues, a cannabis company and an archdiocese plagued by sex-abuse allegations. These are some of the more than 110 companies that declared bankruptcy in the U.S. this year and blamed Covid-19 in part for their demise.

Many were in deep financial trouble even before governors ordered non-essential businesses shut to help contain the spread of the virus. Most will reorganize and emerge from court smaller and less-indebted. The hardest hit, however, are selling off assets and closing for good.

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HHS HRSA Provider Relief Fund Webinars

CARES Act Provider Relief Fund

The Provider Relief Funds supports American families, workers, and the heroic healthcare providers in the battle against the COVID-19 outbreak. HHS is distributing $175 billion to hospitals and healthcare providers on the front lines of the coronavirus response.

HHS expects to distribute $15 billion to eligible Medicaid and CHIP providers through the Provider Relief Fund. Join our webcast to learn more about the application process. Please pre-register to reserve a spot on your preferred date:

Webinar 6/30 | Financial Sustainability Ideas for EMS

June 30, 2020 | 14:00 ET

Three ambulance leaders with diverse backgrounds share innovative tips for financial sustainability in this fast-paced one hour webinar. From insurance captives to employee engagement to data-driven decision-making, Jamie Pafford-Gresham, P. Sean Tyler, and Wayne Jurecki will lend their unique perspectives on ways to keep service rolling during these extraordinarily challenging times.

Watch On-Demand►

Jamie Pafford-Gresham
CEO, Pafford Medical Services
Director, AAA Board
Chair, AAA Government Affairs Committee
Hope, Arkansas

Wayne Jurecki
COO, Bell Ambulance Service
Director, AAA Board
Milwaukee, Wisconsin

P. Sean Tyler
CEO, Transformative Healthcare
President & CEO, Fallon Ambulance Service
Board Secretary, Massachusetts Ambulance Association
Quincy, Massachusetts

Watch On-Demand►

The Hill | Coronavirus crisis squeezes ambulance operators

From May 19, 2020’s The Hill article by Reid Wilson

…The coronavirus crisis is putting an unexpected financial squeeze on ambulance operators, ratcheting up costs and tanking revenue even as they audibly remind people of the virus’s proliferation throughout the county…

Read the full article featuring interviews with many AAA members, including Bell Ambulance, Empress EMS, Great Falls Emergency Services, and REMSA!

CMS Issues Additional Staffing and Licensing Waivers

On May 1, 2020, CMS updated its “COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing.”  The full document can be viewed by clicking here. In the updated FAQ, CMS answers three important questions related to ambulance vehicle and staffing requirements: Expired Ambulance Operating Licenses. CMS was asked whether a ground ambulance vehicle operating…

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