Maine’s efforts to enhance transparency in healthcare billing have taken a significant step forward with the recent enactment of legislation requiring greater disclosure. Governor Janet Mills signed the bill into law last week, marking a pivotal moment in the state’s healthcare landscape.
The primary objective of the new law is to prevent healthcare systems from charging hospital prices for services rendered at non-hospital sites, such as infusion centers or outpatient clinics. This practice, common among many health care networks, has raised concerns about transparency and fairness in billing.
Under the new law, healthcare providers are mandated to specify the physical location where services are provided when submitting claims for reimbursement. This requirement aims to ensure accuracy and transparency in billing practices, particularly for services delivered outside traditional hospital settings.
Denise McDonough, President of Anthem Blue Cross and Blue Shield in Maine, hailed the legislation as a significant stride towards promoting transparency and fairness in healthcare billing. She highlighted instances where hospitals billed for services, such as drug infusions, at office locations off the hospital campus, resulting in significantly higher costs for patients and employers.
However, not all stakeholders welcomed the change. MaineHealth, a prominent healthcare provider in the state, expressed concerns that the new law could have adverse financial implications for the state’s hospital systems. Katie Fullam Harris, Chief Government Affairs Officer for MaineHealth, cautioned against potential disruptions to hospital financing, likening it to unraveling a piece of fabric.
While the Maine Bureau of Insurance did not take a formal position on the bill, Timothy Schott, Acting Superintendent of the bureau, emphasized the importance of accurate billing to reflect the actual location of healthcare services. Misrepresenting the location of services could lead to higher costs for consumers, impacting premiums and cost-sharing.
The issue of transparency in medical billing extends beyond Maine and is a national concern. Federal rules implemented three years ago require hospitals to disclose prices of services, yet compliance remains a challenge for many hospital operators.
According to the Patient Rights Advocate watchdog group, 40% of Maine hospitals monitored for compliance with federal transparency rules were fully compliant, surpassing the national average. Notably, Maine Medical Center and Eastern Maine Medical Center were found to be fully compliant.
Meanwhile, a legislative task force in Maine examined facility fees charged to patients and recommended advanced warning about these fees and restrictions on their collection. The recommendations, stemming from a 2022 investigation into medical billing practices, aim to address hidden and unexpected charges that can significantly inflate medical bills.
While no legislative action has been introduced in the current session regarding the task force’s recommendations, the issue of healthcare billing transparency remains a focal point for policymakers and stakeholders alike.