You’ll recall that I’ve mentioned our focus on promoting many new ideas to external stakeholders to better measure industry interest on new URAC products that improve quality and value for patients before we “build them out.” These are typically proposed due to strong interest or newsworthiness on a topic. Not all of these ideas will become products, but some will.

Our newest concept for a new URAC product is focused on “surprise billing”. This term commonly refers to a practice that occurs when a patient receives services at an in-network facility that is on their health plan, but is billed by a provider that is out-of-network or outside their health plan. Those bills are usually unexpected and not covered by insurance – thus “surprise bills.” Given the network coverage dynamics taking place within healthcare, the impact on consumers has grown significantly over the last few years. In response to public demand, Congress and state policymakers have taken steps to protect patients from this billing practice. 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, much like IROs settling care disputes.

To better support policymakers and provide quality benchmarks for this newly devised role, URAC will explore best practices to create new standards for IROs serving as arbiters in billing disputes. 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 and interest is found, URAC will release a draft set of standards for public comment.

If you have any questions or wish to learn more about this effort, please let me know!