Healthcare providers that received Provider Relief Fund (PRF) monies will be assessed on how they billed for out-of-network patients who received treatment for COVID-19.
Healthcare providers and hospitals that received funding from the Provider Relief Fund (PRF) will be audited for their compliance of the balanced billing requirement (or "surprise billing"), a requirement they must follow to receive the funds. The PRF reimburses eligible healthcare providers for related expenses or lost revenue due to COVID-19. The PRF funded $178 billion to providers and hospitals through the CARES Act, Paycheck Protection and Health Care Enhancement Act, and Consolidated Appropriations Act, 2021.
The U.S. Department of Health and Human Services (HHS), Office of Inspector General, plans to conduct a nationwide audit to determine whether hospitals that received PRF funding complied with the billing requirements for COVID patients. This requirement stipulates that those hospitals must not pursue out-of-pocket payments from COVID patients whose bill exceeded "what the patients otherwise would have been required to pay" for in-network care.
"We will assess how bills were calculated for out-of-network patients admitted for COVID-19 treatment, review supporting documentation for compliance, and assess procedural controls and monitoring to ensure compliance with the balance billing requirement," an HHS statement said.
In related news about surprise billing, the Texas Medical Association (TMA) filed a brief yesterday asserting its opposition to a federal ruling that TMA thinks unfairly favors health insurers in situations to resolve payment disputes between payers and physicians via the No Surprises Act. The brief stated that the rule fails to implement the No Surprises Act the way Congress wrote it.
"The last thing federal regulators should do is make health care more expensive and less accessible for people when they need it, especially during a pandemic," E. Linda Villarreal, MD, TMA president said in a statement. "The courts must reject the federal agencies' flawed approach, because it goes against the public interest and our democratic process."
“The last thing federal regulators should do is make health care more expensive and less accessible for people when they need it, especially during a pandemic.”
E. Linda Villarreal, MD, TMA president
Jasmyne Ray is the revenue cycle editor at HealthLeaders.