Hern and Kuster release bipartisan transparent billing legislation
Washington, May 24, 2023
WASHINGTON, DC – Representatives Kevin Hern (OK-01) and Annie Kuster (NH-02) introduced the Facilitating Accountability in Reimbursements Act (FAIR Act) to harmonize billing practices in off campus hospital outpatient facilities to reflect the site of care.
Off-campus hospital outpatient departments are currently being paid higher by Medicare for offering the same services as physician offices. That’s because hospitals can purchase an off-campus physician practice and use their hospital’s national provider identification (NPI) number to bill the government and private insurance at hospital rates. As a result, hospitals have been buying physician practices and the next day are able to charge more money for the same service, by the same doctor, at the same location.
The FAIR Act would fix this issue by ensuring all off-campus outpatient departments have separate NPIs by January 1, 2025. Second, this bill will direct CMS to prioritize auditing recently converted facilities to ensure they are meeting the remote location of a hospital facility requirements.
“We are spending $4 trillion a year on health care,” said Rep. Hern. “It is time for Congress to identify government policies driving up cost and unhealthy market consolidation. Requiring medical providers to adequately report their site of service will help Congress identify bad actors in the industry. Anne and I are working closely to ensure Americans are not deceived by dishonest billing.”
“Patients in New Hampshire and all across the country deserve to know what they are being charged for when they get medical care, and our health care providers deserve a system that allows them to provide the best care possible,” said Congresswoman Annie Kuster (NH-02). “I am proud to introduce the Facilitating Accountability in Reimbursement Act to help create a more transparent health care billing system.”
The FAIR Act has earned support from multiple stakeholders.
“If you see your doctor for a checkup you shouldn’t pay for a hospital visit. Patients and families deserve a Personal Option in health care that puts an end to dishonest billing and surprise unexpected costs. Americans for Prosperity is proud to lead a bipartisan coalition letter urging Congress to advance site-neutral payment reform and site of service billing transparency. We are incredibly thankful that Rep. Kevin Hern. and Rep. Anne Kuster are leading this important proposal to protect families from dishonest medical bills,” said Charlie Katebi, Senior Policy Analyst, Americans for Prosperity.
“For over 40 years, NFIB small business owners have ranked the cost of health insurance as the number one, long-term small business problem, and 98% of small employers cite health costs will become unsustainable in the next decade. We applaud Congressman Hern's and Congresswoman Kuster's commitment to providing relief to small businesses and their employees by addressing the underlying cost drivers of health insurance and by increasing healthcare transparency and competition in the market. If small businesses thrive, we all thrive.” said Josselin Castillo, Manager of Federal Health Policy, National Federation of Independent Business (NFIB)
“The trajectory of health care costs is both unsustainable and exacerbated by opaque billing practices. The Facilitating Accountability in Reimbursement Act is an important step to correct this problem by shining a light on disparities in cost of care at hospital and non-hospital settings – and extending this transparency to private sector plans. We applaud Representatives Hern and Kuster for recognizing the challenges faced by employers and families who pay for health care services and for their bipartisan leadership in addressing this serious issue,” said James Klein, president of American Benefits Council.
ERIC President and CEO James Gelfand on introduction of The Facilitating Accountability in Reimbursement Act: “On behalf of The ERISA Industry Committee (ERIC), representing the largest employers in the country, thank you for introducing The Facilitating Accountability in Reimbursement Act. We support efforts by Congress to address the need for site neutral payments, to eliminate incentives for consolidation within the health care system, and to ensure patients are not charged inappropriately for the care they receive – all key elements to achieving health care affordability for employers, workers, and their families. This bill, by addressing a commonsense billing issue, will increase much needed transparency and lead to significant savings overall for taxpayers, employers, unions, and patients. ERIC strongly supports this bill and thanks Representatives Hern and Kuster for their leadership on this critical issue.”
“The Partnership for Employer-Sponsored Coverage (P4ESC) strongly supports legislation to combat dishonest billing practices,” said P4ESC Executive Director Neil Trautwein. “P4ESC commends Reps. Kevin Hern (R-OK-01) and Annie Kuster (D-NH-02) for their bipartisan bill targeting big hospital systems that charge consumers and employer plans far higher costs by defining a doctor’s office as a hospital through consolidation. Shame on them and our great appreciation to Reps. Hern and Kuster for their new bill!”
The Alliance to Fight for Health Care said, “Patients should not have to pay more simply because a hospital buys a doctor’s office and engages in billing practices that obscure the location of care. The Alliance to Fight for Health Care, which is committed to strengthening and protecting employer-provided health care coverage and making health care more affordable for all Americans, applauds Representatives Hern and Kuster for their bipartisan leadership on the Facilitating Accountability in Reimbursement (FAIR) Act. The FAIR Act is an important first step towards site-neutral payment reform, injecting transparency into hospital billing to ensure patients pay for the service that is provided instead of the name on the door.”
“The introduction of this legislation is another important bipartisan milestone in the effort to address anti-competitive hospital practices that drive up healthcare prices,” said Alex Schriver, executive director of Better Solutions for Healthcare. “This measure will end dishonest hospital billing and lower prices for employers and consumers by ensuring that patients are billed for the services they receive at the location where they receive them. This reform is one of the most important steps we can take to defend patients and consumers, and we urge lawmakers to take action this Congress.”
“No one should have to pay more for health care services based only on the location of care. This bipartisan, commonsense solution prioritizes the health and well-being of patients by promoting affordability, transparency and fairness. We are committed to advancing real solutions to improve care and lower costs for all Americans and look forward to working with Congress to pass this legislation as a critical step forward in achieving this goal.” David Merritt, senior vice president of policy and advocacy, Blue Cross Blue Shield Association.
You can read the full bill text here.