Bill · H.R. 3023· House(119-HR-3023)
Preventing Hospital Overbilling of Medicare Act
- Introduced
- 4/24/2025
- Last activity
- 4/24/2025 — Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Sponsored by
- Victoria Spartz
- Cosponsors
- None
- Introduced
- In Committee
What this bill would do
The ``Preventing Hospital Overbilling of Medicare Act'' aims to address incorrect billing by off-campus hospital locations. It seeks to promote site-neutral payments by redefining off-campus outpatient departments and removing certain exceptions. The bill requires these off-campus departments to be assigned a separate, unique health identifier from their main provider. It also establishes new billing requirements for Medicare and other health care providers. Additionally, the Secretary of Health and Human Services is directed to request that the National Association of Insurance Commissioners create a model Act or regulation regarding these billing issues.
Yes· 3 of 7
Does this reduce what the federal government spends?+5
The bill promotes site-neutral payment policies to reduce expenditures for services furnished under Medicare.
Would people over 65 be better off under this?+4
The bill aims to reduce overbilling for Medicare services used by seniors.
Would retired people be better off under this?+4
The bill protects retirees from hospital overbilling through site-neutral payment policies.
The opposite
Does this make health care easier to get in general?-2
The removal of the site-neutral exception for off-campus emergency departments may affect how emergency care is billed and accessed.
Who it would affect, and how
Potential Positive Impacts for People
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Reduction in Expenditures: The bill grants the Secretary authority to promote site-neutral payment policies to reduce expenditures related to items and services furnished under this part, specifically by preventing hospitals from billing off-campus services as if they were provided at the main hospital location (Section 2(a)(3)).
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Standardized Billing for Insurance: By requiring off-campus departments to use a separate, unique health identifier, the bill establishes specific billing standards for claims submitted to group health plans or health insurance issuers (Section 2(b)(1) and Section 2(c)(2)).
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Claim Rejection Capabilities: The Secretary will request a model Act or regulation that would allow health insurance issuers and group health plans to reject claims if the off-campus department does not bill according to the new requirements (Section 2(d)).
Potential Negative Impacts for People
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Changes to Emergency Department Exceptions: The bill removes a site-neutral exception for off-campus emergency departments, which will take effect before January 1, 2026 (Section 2(a)(2)).
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New Billing Requirements for Providers: Health care providers will be prohibited from submitting claims to group health plans or insurance issuers, and cannot hold individuals liable for items and services, unless they follow the new unique health identifier and specific transaction form requirements (Section 2(c)(2)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Demographic And Interest Groups
- Good For Retirees+4Good For Seniors+4Good For Low Income Households+3
- Economy And Finance
- Reduces Government Spending+5Improves Consumer Protection+4
- Governance And Ideology
- Improves Government Transparency+4
- Healthcare
- Increases Medicare Funding+3Improves Healthcare Access-2
- 4/24/2025
- Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Introduced in House