Sponsor
Victoria Spartz
Representative · R-IN
Representative · R-IN
The bill improves billing transparency and reduces Medicare patient costs via site‑neutral payments and unique identifiers, but it creates compliance and IT costs for providers and insurers and raises the risk of claim delays, denials, or changed emergency‑care patterns during implementation.
Medicare beneficiaries and patients with chronic conditions will likely face lower out-of-pocket costs when receiving care at off‑campus hospital departments because payments will be made more site‑neutrally.
Medicare beneficiaries and patients will receive clearer bills and greater certainty about which provider treated them because each off‑campus department must have its own NPI/unique identifier and use standard claim forms starting Jan 1, 2026.
State governments, insurers, and group health plans can more easily detect and reject misrouted or improperly billed hospital‑level claims, improving claims accuracy and reducing improper payments.
Medicare beneficiaries and other patients could experience claim rejections or payment delays if providers or insurers fail to adopt the new billing identifiers/forms, leading to denied claims or unexpected bills.
Hospitals and health systems will incur administrative and IT costs to assign NPIs, update systems, and change billing workflows by Jan 1, 2026, increasing provider expenses that could be passed on to patients.
Medicare beneficiaries and hospitals could see shifts in emergency care access or costs because eliminating the off‑campus emergency department exception may change where services are located or how emergency visits are billed.
Based on analysis of 2 sections of legislative text.
Stops hospitals from billing off‑campus outpatient departments as hospital services and requires separate provider IDs and outpatient claim forms starting Jan 1, 2026.
Official title: To amend title XVIII of the Social Security Act and title XXVII of the Public Health Service Act to address incorrect billing by off-campus hospital locations, and for other purposes.
Introduced April 24, 2025 by Victoria Spartz · Last progress April 24, 2025
Prevents hospitals from billing off‑campus outpatient departments as hospital services and requires those departments to use separate provider identifiers and standard outpatient claims forms beginning January 1, 2026. It narrows the legal definition of an off‑campus outpatient department to the pre‑Bipartisan Budget Act of 2015 campus definition and gives HHS explicit authority to adopt methods to promote site‑neutral payments. Requires each off‑campus outpatient department to obtain its own NPI/unique health identifier and directs Medicare, Medicare Advantage, and group/individual health plans to require the department’s identifier and submit claims on HIPAA X12 837P or CMS‑1500 forms for services furnished on or after January 1, 2026; HHS must also ask the NAIC to adopt a model law allowing issuers to reject noncompliant claims within six months of enactment.