The act would:

Establish an independent dispute resolution (IDR) process, or arbitration process, for determinations of the rates to be paid by health plans for out-of-network care.
Set billing standards for air ambulance services.
Set standards for disclosures related to in-network and out-of-network deductibles and out-of-pocket limitations.
Provide consumer protections, through external reviews, in cases involving some surprise medical bills.
Set continuity of care standards.
Would create a national data reporting format for employer self-insured health plan claims, to make it easier for employers to send.
Let states require self-insured employer health plans to contribute data to state All Payer Claims Databases.
Set standards for health plan provider directory accuracy.
Set standards for timely patient billing.
Establish an advisory committee on ground ambulance and patient billing.

Although the discussion draft lets providers turn to IDR organizations, to resolve disputes, rather than using standard fee schedules, the IDR organizations themselves would have to base their rulings partly on "the median in-network rate" for care, according to the official discussion draft summary.

Instant Insights /

House surprise billing deal gets bipartisan support in Senate

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