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HHS Now Introduces New Surprise Bill Compliance Rules

The extension to the No Surprise Bill has released a month ago, which is supposed to prohibit the surprise bills for patients. A step in the direction of optimizing medical billing services!

HHS (United States Department of Health and Human Services) and other federal departments came up with a notice known as NPRM (Notice of proposed rulemaking). This regulation will allow authorities to penalize clinicians and billing service providers for up to $10,000.

NPRM Validates the Existing Penalties for Surprise Bill Violation

To be exact, the new regulation comes as the Reporting Requirements Regarding Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement. And it codifies penalties for PHS (Public Health Service) Act for violations under Part E.

The new rule will allow putting sanctions and fines as civil monetary penalties. It will also empower health insurance payers to keep a check on surprise medical bills.

The Explanation of the NPRM Law

The new law also explains a framework to establish authority over healthcare service providers, hospitals, and providers of air ambulance services.

How will HHS Put the Penalty over a Surprise Bill?

HHS will also have the authority to ask for any documents in case of a complaint, and it can happen within six years of the claim processing, compilation, and submission. Thus, medical billing services would also be playing a very important part, and they must have all documentation to support their claim.

Moreover, it is also to keep in mind that the penalty and the complaint repercussions would be judged over the level of violation.

Action for Air Ambulance Service Provider

If air ambulance service providers fail to provide any document, they can receive a penalty of up to $10,000 under the Social Security Act.

The data includes:

  • Payer data
  • Claim denials
  • Air ambulance bases and aircraft
  • Transportation and medical costs
  • Number and nature of air ambulance transports

The rule is particularly for the air ambulance service providers as it is a consolidated market.

These rules established by the Biden-Harris administration would allow authorities to get any data and read the market trends. Moreover, they would be able to give their insights based on the available data.


It is indeed a great step in terms of preventing patients from the hideous surprise bills. Besides, it can make healthcare services affordable for everyone, be it providers, payers, or medical billing services. Ultimately, this law grants rights to CMS to take action against facilities that do not comply with the regulations.

We could expect some more laws to come as an extension to this. This Act will go into effect from January 1, 2022.

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HHS Says: No Surprise Bills for COVID Patients

HHS – The U.S. Department of Health and Human Services (HHS) reserved excessive budget as emergency funds for COVID-19 response efforts. Now, the healthcare professionals affected by the pandemic in any sort (lack of services, resources availability, etc.) can apply for assistance and compensate for their loss.

However, once they apply for these COVID-19 relief funds, the government bars them from sending out-of-pocket care expenses to corona patients. In simpler terms, as claimed by the HHS officials, this program exempts patients from surprise medical bills and supports the financial concerns of all stakeholders (physicians and patients).

Medical billing services of this day and age, in alignment with the program, have to work accordingly. Since they represent practices and their awareness matters, the peace of physicians and patients have to be their top priority.

Just a Reminder, What Are Surprise Medical Bills?

Surprise medical bills are where a patient has to pay the difference between what the insurance pays for them and what the actual charges are for services taken. For instance, if you went to see your doctor, and the care costs reach up to $100 while your insurance only covers $70, the difference, $30, is what you have to pay out of your pocket.

COVID-19 Funds – Terms of Use

In terms and conditions of the emergency relief fund of COVID-19, HHS established that they consider every patient a COVID affectee, whether it is a probable or an actual case. Hospitals and medical billing services have to sign a deal that would not charge out-of-pocket expenses from patients if their insurance plan does not include those services (a practice referred to as surprise billing).

The debate continues if the HHS has banned surprise bills, which was a primary cause of distress for patients and physicians. Because medical billing outsourcing companies often find it hard to collect additional charges from patients.

HHS states that they are trying to clarify terms, which will ultimately help in comprehending the implications of getting the COVID aid. For now, the surprise billing banning extends to only COVID-positive cases.

Healthcare leaders are also in confusion about the legal complications and challenges of the payment balancing. There is still a lot of clarity required to satisfy all queries.

Surprise Bills during Pandemic – The Role of Medical Billing Services

Apart from the HHS efforts, many states are coming forward with policies that prevent patients from surprise billing. It means it is time to consider patients with out-of-network healthcare plans as in-network patients.

It is a critical step toward balancing the shaky healthcare economy and stop the high consumption of resources. Besides, the instability in the healthcare ecosystem is making it nearly impossible to meet ends from patient and physician perspectives.

Medical billing services assist practices with payments in this regard. They also furnish weekly or monthly reports, as suited, to relieve physicians of any revenue stresses.

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Physicians for fair coverage, the non-profit, have proposed a ban on surprise medical bills already. The government’s appropriate measures against surprise billing for COVID patients are incredible and in line with the aspirations of COVID affectees. We must continue this collective effort against balance billing, the goal of which is to attain peace of mind for our doctors and patients.

Via reducing or eliminating surprise bills, provided with a balanced financial solution for medical practices and medical billing services, can make up for lost revenues and maximize revenue opportunities.

What are your thoughts on this?