Bill > HR3023

This bill aims to address hospital overbilling in Medicare by implementing several key provisions focused on "site-neutral" payments for off-campus hospital departments. Specifically, the bill will require off-campus hospital outpatient departments to be assigned unique health identifiers separate from their main hospital, and mandate that these departments bill Medicare and other health insurance providers using these specific identifiers on standard billing forms like HIPAA X12 837P or CMS 1500. Starting January 1, 2026, the bill removes certain exceptions that currently allow off-campus departments to bill at higher hospital rates, effectively creating more uniform pricing across different medical service locations. The legislation also empowers the Secretary of Health and Human Services to take actions preventing hospitals from billing off-campus department services at higher hospital rates, and requests the National Association of Insurance Commissioners to develop a model regulation allowing insurance providers to reject claims from off-campus departments that do not comply with the new billing requirements. These changes are intended to reduce healthcare costs by preventing hospitals from charging higher rates for services provided at off-campus locations that are essentially equivalent to less expensive outpatient services.

Business and Industry

https://www.congress.gov/bill/119th-congress/house-bill/3023/all-info