FAIR Act

To ensure fair billing practices for items and services furnished by off-campus outpatient departments of a provider. 1. Short title This Act may be cited as the Facilitating Accountability In Reimbursements Act FAIR Act 2. Ensuring fair billing practices for items and services furnished by off-campus outpatient departments of a provider (a) Separate NPIs for off-Campus outpatient departments of a provider (1) In general Section 1173(b) of the Social Security Act ( 42 U.S.C. 1320d–2(b) (3) Ensuring separate NPIs for off-campus outpatient departments of a provider The standards specified under paragraph (1) shall ensure that, not later than January 1, 2025, each off-campus outpatient department of a provider (as defined in section 1833(t)(21)(B)) is assigned a separate unique health identifier from such provider. . (2) Treatment of certain departments as subparts of a hospital Not later than January 1, 2025, the Secretary of Health and Human Services shall revise sections 162.408 and 162.410 of title 45, Code of Federal Regulations, to ensure that each off-campus outpatient department of a provider (as defined in section 1833(t)(21)(B) of the Social Security Act ( 42 U.S.C. 1395l(t)(21)(B) (b) Off-Campus departments of a provider billing requirements (1) Medicare (A) In general Section 1866(a)(1) of the Social Security Act ( 42 U.S.C. 1395cc(a)(1) (i) in subparagraph (X), by striking and (ii) in subparagraph (Y)(ii)(V), by striking the period and inserting , and (iii) by inserting after subparagraph (Y) the following new subparagraph: (Z) in the case of a hospital with an off-campus outpatient department of a provider (as defined in section 1833(t)(21)(B)), with respect to items and services furnished at such department of a provider on or after January 1, 2025, to bill under this title (including under part C of this title) for such items and services using the unique health identifier established for such department of a provider pursuant to section 1173(b)(3) on a HIPAA X12 837P transaction or CMS 1500 form (or a successor transaction or form). . (B) Compliance reviews In conducting any regular reviews of off-campus outpatient departments of a provider (as defined in section 1833(t)(21)(B) of the Social Security Act ( 42 U.S.C. 1395l(t)(21)(B) 42 U.S.C. 1395l(t) 42 U.S.C. 1395j et seq. 42 U.S.C. 1395ww(d)(2)(D) (2) Other providers Part E of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–131 et seq. 2799B–10. Billing requirements for off-campus departments of a provider A health care provider may not, with respect to items and services furnished to an individual at an off-campus outpatient department of a provider (as defined in section 1833(t)(21)(B) of the Social Security Act), submit a claim for such items and services to a group health plan or health insurance issuer, and may not hold such individual liable for such items and services, unless such items and services are billed— (1) using the separate unique health identifier established for such department pursuant to section 1173(b)(3) of such Act; and (2) on a HIPAA X12 837P transaction or CMS 1500 form (or a successor transaction or form). . (3) Effective date The amendment made by paragraph (1) shall apply with respect to claims submitted for items and services furnished on or after January 1, 2025.

Summary: Facilitating Accountability In Reimbursements Act or the FAIR Act This bill requires health care providers to use separate, unique health identifiers when submitting a claim to a health insurance issuer for services provided at an off-campus outpatient department.