Hospitals Walk Fine Line With Post-Stabilization in No Surprises Act

Like other hospitals, Pomona Valley Hospital Medical Center in California has been wrestling with its obligations under the No Surprises Act for post-stabilization services. If patients are being treated out of network for an emergency, their commercial insurers may start calling when patients move to post-stabilization to transfer them to an in-network facility, said Compliance Officer Kathy Perkins. But patient consent related to post-stabilization “can’t be coerced” under the No Surprises Act, and it’s possible a state’s surprise medical billing law on post-stabilization could supersede the federal version. It’s a complicated calculus that’s causing some confusion.

“Patients are put in the middle and the clear goal of the No Surprises Act is to take them out of the middle,” she said.

Post-stabilization is a challenging area of the No Surprises Act because hospitals must determine whether their state law applies instead of the No Surprises Act and if it doesn’t, they must cross a high threshold to bill patients beyond what the out-of-network payer offers as reimbursement, said Brenna Jenny, former CMS legal officer. “There are a lot of open questions,” said Jenny, now with Sidley Austin LLP.

This document is only available to subscribers. Please log in or purchase access.
 


Would you like to read this entire article?

If you already subscribe to this publication, just log in. If not, let us send you an email with a link that will allow you to read the entire article for free. Just complete the following form.

* required field