On July 12, 2023, the House Committee on Education and the Workforce approved the Transparency in Billing Act (the Bill), which would require commercial insurance plans to reject hospital claims for outpatient services furnished in off-campus outpatient departments unless they include a unique national provider identifier (NPI) associated with the department where the service was furnished.

The Bill would amend Section 901 of the Employment Retirement Income Security Act of 1974 (ERISA) by adding additional billing requirements for the payment of services furnished at an off-campus outpatient department of a provider. The Bill would require hospitals to obtain a separate unique NPI and use that identifier on each claim for the department where the items and services were provided. A process for reporting suspected violations of these requirements would be established within a year of the enactment of these billing requirements.

The Bill would also amend Section 502 of ERISA by adding a civil monetary penalty against a hospital for violating Section 901. Hospitals with thirty beds or less could be fined up to $300 per day that a violation occurs. Hospitals with more than thirty beds could be fined up to $5,500 per day that a violation occurs.

While the Bill’s prospects for passage by the full Congress remain unclear, this development marks yet another instance of legislative scrutiny on hospital outpatient billing. Earlier this year, House committees held hearings on several new bills aiming to expand site neutrality in Medicare billing. However, this Bill would go beyond a focus on governmental payors and address hospital outpatient billing of private payors.

The Bill can be found here.