Hbma Adopts Policy Framework For Unexpected Out-of-network Medical Bills

April 22, 2019 - PRLog -- CONTACT: Kurt Gallagher | kgallagher@hbma.org
HBMA ADOPTS POLICY FRAMEWORK FOR UNEXPECTED OUT-OF-NETWORK MEDICAL BILLS
Document Offers Solutions to Sticky Issue of "Surprise" Medical Bills
(WASHINGTON) – Today the Healthcare Business Management Association (HBMA)
announced a new policy framework for federal and state legislative proposals to address
unexpected out-of-network (OON) medical billing scenarios (a.k.a., "surprise" medical bills). The
"HBMA Framework for Out-of-Network Billing Legislation" (Policy Framework) affirms HBMA's
commitment to protecting patients from unexpected medical bills and points out the role health
insurance plans must play to address this important issue.
The Policy Framework defines HBMA's position on four key aspects related to out-of-network
medical bills: 1. how to define "surprise" billing scenarios; 2. how to protect patients; 3. how to
reimburse the OON provider; and 4. how health insurance plans can play a role in preventing
"surprise" billing scenarios.
"More oversight of health insurance plans is needed to protect patients from unexpected out-ofnetwork
medical bills. The 'HBMA Framework for Out-of-Network Billing Legislation' highlights
that 'surprise' medical bills really are due to health insurance plans creating barriers for doctors
to enroll in networks, which result in gaps in coverage for the patients they see," said HBMA
President Mick Polo.
"Surprise" out-of-network medical bill scenarios are currently regulated at the state level. Since
the end of 2018, the U.S. Congress has been discussing how federal legislation can fill gaps in
state laws and provide protections to patients in states that have not enacted a "surprise" billing
law.
The Policy Framework was developed by the HBMA Government Relations Committee and the
HBMA Out-of-Network Billing Task Force. The HBMA Government Relations Committee
became concerned about proposed federal legislation that would adversely affect the ability of
doctors and other healthcare providers to negotiate fair terms to become an in network provider
with health insurance plans. The Government Relations Committee also recognized how federal
proposals overlook how health insurance plans contribute to "surprise" billing scenarios such as
with narrow networks, inaccurate directories for doctors and other healthcare providers,
inaccessible networks, inadequate coverage policies, and unreasonable requirements to allow
doctors to participate in healthcare networks.
In January, the HBMA Government Relations Committee created a task force to study federal
policy proposals and recommend how HBMA can advocate on this issue on behalf of the
healthcare revenue cycle management industry. The full text of the Policy Framework is
available at www.hbma.org.
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About the Healthcare Business Management Association (HBMA)
HBMA is a non-profit, member-led trade association of companies that support doctors and
other medical providers by handling their medical billing and revenue collection processes,
services known as revenue cycle management (RCM). HBMA works with legislative
stakeholders and federal agencies in Washington, D.C. to improve the business of medical
billing and the practice of healthcare. Since its inception in 1993, HBMA and its members have
encouraged professional development and adherence to the HBMA Code of Ethics, advocated
on behalf of the RCM profession, and promoted business development through educational
events, networking opportunities, certification programs, and a wide range of affiliated vendor
resources. For more information about HBMA, visit the www.hbma.org.