Monday, February 27, 2023 | The Latest Research, Commentary, And News From Health Affairs
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"Using commercial insurance claims, we found that 28 percent of emergency transports and 26 percent of nonemergency transports resulted in a potential out-of-network surprise bill," the authors
report.
The authors find that being transported by a private-sector ambulance in an emergency is associated with substantially higher allowed amounts, patient cost sharing, and potential surprise bills compared with being transported by a public-sector ambulance.
These findings highlight substantial patient liability and important differences in pricing and billing patterns between public- and private-sector ground ambulance organizations.
This research is especially interesting given the current surprise-billing policy landscape.
The federal No Surprises Act, which took effect in January 2022, bans surprise billing for those with commercial insurance in most situations where patients cannot choose their clinician or service provider. However, the legislation omitted ground ambulance transports.
Travis Williams and coauthors explain the 2023 final rule on Medicare Advantage Risk Adjustment Data Validation (RADV) audits, examining how the rule lets insurers keep billions in overpayments.
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