URAC to Explore Standards for Surprise-Billing Arbiters

health billing concept. US bills on health insurance paperwork

In response to public demand, Congress and state policymakers have taken steps to protect patients from “surprise-billing”. This term commonly refers to a practice that occurs when a patient receives services at an in-network facility but is billed by a provider that is out-of-network. Given the network development dynamics taking place within healthcare, the impact on consumers has grown precipitously over the last few years.

“Given the financial hardship this practice places on even the most diligent patients, policymakers are right to protect patients from this confusion in our delivery system,” said Shawn Griffin, M.D., URAC President and CEO.

Several states have adopted laws that hold patients harmless from surprise-billing and require health plans and providers to resolve billing issues directly or through an independent arbiter. A few have chosen accredited independent review organizations (IROs) to serve as their state’s independent arbiter in surprise-billing disputes.

“Accredited IROs have a 20-year history of protecting patients by serving as trusted independent clinical experts, they are the logical choice to serve in this role,” said Dr. Griffin. “To better support policymakers and provide quality benchmarks for this newly devised role, URAC will explore best practices to create standards for IROs serving as arbiters in billing disputes.”

URAC will look to craft standards specific to this new legislation in the areas where accredited IROs have strength:

  • Consumer Protection
  • Staff Credentialing and Qualifications
  • Avoiding Conflict-of-Interest
  • Timely and Transparent Communication
  • Timely Issue Resolution

Over the coming weeks URAC will work closely with industry stakeholders to review best practices associated with billing transparency and due process, should standards be appropriate, URAC will release a draft set of standards for public comment.

If you are interested in participating, please contact Robin Adams, Vice President, Strategy and Product Development at radams@urac.org no later than June 30, 2019.