Surprise billing rule establishes dispute resolution process for patients, providers, and plans

The Office of Personnel Management and the Departments of Health and Human Services (HHS), Labor, and Treasury released the second interim final rule (IFR) implementing provisions of the No Surprises Act. This rule follows prior rulemaking outlining patient protections against surprise medical bills, establishing out-of-pocket limits, and notice and consent requirements.

This rule implements independent dispute resolution (IDR) processes for providers, patients, and health plans and takes effect Jan. 1, 2022. The rule also outlines the process the agencies will use to evaluate and certify IDR entities for the arbitration process.

More information is available on the associated Centers for Medicare & Medicaid Services (CMS) fact sheet and agency press release. As the agencies release additional information, it will be posted on the new CMS surprise billing landing page. Be on the lookout for MGMA’s analysis and comments in response to the second IFR.

New guidance from HHS on HIPAA and COVID-19 vaccination status

HHS, through its Office for Civil Rights, issued new guidance on the relationship between the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and COVID-19 vaccination status in the workplace. This practical guidance serves to help businesses and healthcare entities better understand when the HIPAA Privacy Rule applies to disclosures of vaccination status, particularly as it pertains to employees and patients.

Notably, the guidance is an important reminder that the HIPAA Privacy Rule does not apply to employers because they are not included in the definition of a HIPAA covered entity or business associate.

Members may also wish to consult the MGMA HIPAA landing page for additional resources. 

MIPS virtual group election period for PY 2022 now open

The virtual group election process for the 2022 performance year for the Merit-based Incentive Payment System (MIPS) is now open. CMS has published a 2022 Virtual Group Toolkit providing detailed information about the virtual group election and participation process. Virtual group elections must be submitted via email to CMS by Dec. 31, 2021, at 11:59 PM (ET).

More information about MIPS participation options and the virtual group election process is available on the CMS Quality Payment Program website.