There are thousands of stories that highlight both the lack of transparency in hospital billing and the inadequate patient protections in our healthcare system. Unexpected high medical expenses devastate these individuals, as compounding bills, high inflation, and the rising cost of living strain households with no relief in sight. The steady rise in healthcare costs can partly be attributed to big hospitals and private equity firms acquiring private physician practices.
Nearly two years after a surprise medical bill ban took effect, the process for settling billing disputes between insurers and providers is still mired in litigation and many cases remain unresolved.
The new proposal could infuse roughly $700 million in new revenue for hospitals, including mental healthcare. The program proposal, which must still be approved by the Centers for Medicare and Medicaid (CMS), offers Medicaid reimbursement reforms estimated to infuse nearly $700 million in new revenue for the state’s hospitals on annual basis. If approved, the plan would increase the Mississippi Hospital Access Program (MHAP) reimbursement to Medicaid members and would supplement the program’s base rates for hospitals by reimbursing inpatient and outpatient hospital services in the fee-for-service system.
The Supreme Court ruled unanimously last year that HHS unlawfully cut the payments to hospitals without following proper procedure, including conducting a survey of the hospitals’ acquisition cost of the drugs from pharmaceutical drugmakers. And now, thousands of U.S. hospitals are set to recoup more than $9 billion under a proposed remedy that the federal agency rolled out this summer. As part of that, more than 40 Indiana hospitals stand to collect a total of $222.2 million in lump-sum repayments to make up for what they lost over the past five years.
There are thousands of stories that highlight both the lack of transparency in hospital billing and the inadequate patient protections in our healthcare system.
As a physician in North Carolina, my life’s mission has been to provide the highest level of care to my patients and community. This goal has become increasingly difficult as a federal law called the No Surprises Act, originally meant to protect both patients and doctors, now threatens the viability of rural health care across our country. In 2020, a bipartisan coalition in Congress passed the NSA to establish a fair process for health insurers and physicians to work out payment disputes and remove patients from the middle.