Maine will require greater health care billing transparency under a bill passed by the Legislature and signed into law last week by Gov. Janet Mills.

The goal is to prevent health care systems from charging hospital prices for services provided at non-hospital sites, such as infusion centers or outpatient clinics.

Many off-site services are provided by the same health care networks that operate hospitals. MaineHealth owns Maine Medical Center in Portland, for example, but also provides many outpatient services at buildings not on a hospital campus. Northern Light Health owns Eastern Maine Medical Center in Bangor and Mercy in Portland and also provides an array of off-campus services.

The new law says health care providers “must identify the physical location where services are rendered” when submitting claims seeking reimbursement.

Denise McDonough, president of Anthem Blue Cross and Blue Shield in Maine, said the law “marks an important step toward promoting greater transparency and fairness in healthcare billing.” In some cases, Anthem officials say, contracts between providers and insurance companies would preclude charging hospital prices at off-campus buildings.

“At Anthem, we have seen claims come in showing hospitals billing for services like drug infusions at office locations that are off the hospital campus but billed as if the service had taken place at the hospital – where costs are much higher, both in terms of members’ out-of-pocket costs and employers’ premiums,” McDonough said in a statement. “Based on our claims data, drugs administered in an office location but billed as if administered in a hospital resulted in a double or even triple increase in the cost of those drugs. That’s wrong, and one of the many issues contributing to our healthcare affordability problem in Maine.”

MaineHealth opposed the change, but the impact on hospital finances was minimized after the bill was amended last year to remove specific limits on charges in off-campus settings.

“Fortunately, the final version of this legislation recognized that hospital organizations operate 24 hours a day, seven days a week, maintaining an extensive care infrastructure in the communities they serve,” said John Porter, MaineHealth spokesman, in a statement. “The legislation says that patient bills must make clear when services are provided in a hospital facility, including when services are rendered at ‘hospital off-campus locations.’ This approach provides for greater transparency without making it more difficult for our not-for-profit hospital organizations to cover the costs of providing care in our Maine communities.”

The Maine Bureau of Insurance did not take a position on the bill, but Timothy Schott, acting superintendent of the bureau, said in testimony that “it is important for billing to accurately reflect where a health care service is actually performed.”

“Billing for a service that is performed at a less expensive facility at the rate charged for a more expensive facility could have a negative impact on premiums and consumer cost-sharing, leading to higher health care costs for consumers,” Schott said.

Transparency in medical billing is a national issue, and federal rules that went into effect three years ago require hospitals to list prices of services. Many hospital operators are not yet complying.

According to the Patient Rights Advocate watchdog group, 40% of the Maine hospitals monitored for complying with federal transparency rules were fully compliant, which is better than the national average of 36.5%.

Maine Med and EMMC were found to be fully compliant, while Central Maine Medical Center in Lewiston, St. Joseph Hospital in Bangor and St. Mary’s Regional Medical Center in Lewiston were noncompliant.

Meanwhile, a Maine legislative task force that examined so-called facility fees charged to patients at hospitals and other medical settings is calling for advanced warning about the fees and restrictions on when they can be collected. The hidden and unexpected charges can add hundreds of dollars to routine medical bills and are used by hospitals to cover overhead costs and unreimbursed expenses.

The task force, which was created in response to a 2022 Portland Press Herald investigation into medical billing, released a report to lawmakers last month detailing the billing practice and recommending law changes. The recommendations came after the deadline for nonemergency bills and no legislative action has been introduced in the current session.

Copy the Story Link

« Previous

Casco Bay island park honoring North Pole explorer closed for season due to storm damage

Next »

Bernie Sanders to deliver University of New England commencement speech