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Policy brief outlining the Texas Hospital Association’s position and policy considerations regarding federal legislative approaches to surprise medical billing and dispute resolution between healthcare providers and insurers.
Year:
2020
Date of update:
October 2020
Region / Country:
United States
Topic:
Surprise medical billing and healthcare payment policy
Document type:
Policy brief
Organization:
Texas Hospital Association (THA)
Related organizations:
American Hospital Association (AHA)
Audience:
Policymakers, healthcare providers, insurers, and stakeholders in the healthcare system
Policy level:
Federal healthcare policy
Legislative context:
Congressional proposals addressing out-of-network medical billing practices
Key policy mechanisms discussed:
Benchmark reimbursement rates and independent arbitration
Related legislation context:
CARES Act Provider Relief Fund terms and conditions
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Document title:
Supplemental Table 1. RRP after THA and TKA
Abbreviations defined:
RRP = rapid recovery protocol; THA = total hip arthroplasty; TKA = total knee arthroplasty
Clinical setting:
Surgery clinic; Preoperative clinic; Operating room; Postanesthesia care unit; Surgical floor
Medical specialties involved:
Orthopedic surgery; Anesthesiology; Nursing; Physical therapy
Patient population:
Primary elective THA and TKA candidates
Interventions described:
Preoperative education; Antibiotic prophylaxis; Regional anesthesia blocks; Spinal anesthesia; Multimodal analgesia; Tranexamic acid administration; Early mobilization
Perioperative timeline:
Preoperative period to 2-week postoperative visit
Medications referenced:
Cefazolin; Vancomycin; Acetaminophen; Celebrex; Toradol; Dexamethasone; Propofol; Tranexamic acid; Zofran
Discharge criteria included:
Pain controlled with oral medications; Independent ambulation; Afebrile status; Absence of nausea or vomiting
Year:
2016
Location:
Nashville, Tennessee
Topic:
Healthcare Leadership, Patient Safety, Quality Improvement
Document Type:
Conference Call for Presentations
Organization:
Tennessee Nursing Association, Tennessee Organization of Nurse Executives, Tennessee Center for Patient Safety, Tennessee Association for Healthcare Quality
Author:
Not specified
Target Audience:
Healthcare professionals, leaders, and organizations in the healthcare field
Action Period:
October 19, 2016
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2018
Region / City:
Franklin, Tennessee
Theme:
Healthcare, Performance Excellence, Patient Safety
Document Type:
Call for Presentations
Organization / Institution:
Tennessee Hospital Association (THA)
Author:
Tennessee Hospital Association
Target Audience:
Healthcare professionals, clinicians, hospital staff
Period of Validity:
October 17-19, 2018
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2018
Event:
THA Leadership Summit
Date:
October 17, 2018
Location:
Franklin Marriott, Cool Springs, Tennessee, USA
Organizers:
Tennessee Hospital Association, Tennessee Center for Patient Safety, Tennessee Nursing Association, Tennessee Organization of Nurse Executives, Tennessee Society for Organizational Improvement, Tennessee Association for Healthcare Quality
Type of document:
Call for Poster Presentations / Conference Announcement
Audience:
Hospital staff, clinicians, healthcare providers
Deadline for submissions:
July 27, 2018
Notification of acceptance:
August 20, 2018
Topics:
Performance excellence, patient safety, quality improvement, leadership development, interdisciplinary collaboration, healthcare innovation
Instructions:
Submission via email using provided forms, posters must be presented at the session
Year:
2022
Region / City:
United States
Topic:
Healthcare, Consumer Protection, Medical Billing
Document Type:
Informational Page
Agency / Institution:
Centers for Medicare & Medicaid Services (CMS)
Author:
Centers for Medicare & Medicaid Services (CMS)
Target Audience:
Healthcare providers, consumers, dispute resolution organizations
Effective Period:
From January 1, 2022
Approval Date:
January 1, 2022
Revision Date:
Not specified
Year:
2022
Region / City:
United States
Topic:
Health insurance, Medical bills
Document Type:
Consumer Protection Information
Organ / Institution:
Centers for Medicare & Medicaid Services (CMS)
Author:
Centers for Medicare & Medicaid Services (CMS)
Target Audience:
Consumers of healthcare services
Period of Action:
From January 1, 2022
Approval Date:
January 1, 2022
Changes Date:
Not specified
Note:
Description
Year:
2022
Region / City:
USA
Topic:
Healthcare, Consumer Protection
Document Type:
Government Information
Organ / Institution:
Centers for Medicare & Medicaid Services
Author:
Not specified
Target Audience:
Consumers, uninsured and self-paying patients
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Amendments:
Not specified
Year:
2023
Region / City:
Toronto
Theme:
Programming, Software Development
Document Type:
Assignment
Author:
Clix.com
Target Audience:
Students learning programming
Period of Validity:
N/A
Date of Approval:
N/A
Date of Changes:
N/A
Context:
An assignment outlining the development of a software tool to generate clickbait headlines.
Year:
1
Region / City:
Australia
Themes:
Social management, animal exploration, pattern making
Document type:
Episode
Organization:
Unknown
Author:
Unknown
Target audience:
Children
Effective date:
Unknown
Date of changes:
Unknown
Year:
2022
Region / City:
United States
Subject:
Healthcare billing and patient rights
Document Type:
Legal notice / Informational notice
Institution:
Centers for Medicare & Medicaid Services (CMS)
Author:
U.S. Department of Health and Human Services
Target Audience:
Patients receiving medical care
Effective Period:
Ongoing since enactment of the No Surprises Act
Date of Issue:
January 1, 2022
Contact Information:
www.cms.gov/nosurprises/consumers, [email protected], 1-800-985-3059
Note:
Year
Topic:
Bible Study, Second Coming of Jesus
Document Type:
Bible Study Lesson
Target Audience:
Christian believers
Year:
2026
Region / City:
United States, New York
Topic:
Health Insurance, Medical Billing
Document Type:
Informational Guidance
Organization:
New York State Department of Financial Services, Centers for Medicare & Medicaid Services
Audience:
Health insurance consumers
Coverage:
Emergency care, out-of-network services
Key Provisions:
Protections against balance billing and surprise medical bills, cost-sharing limits, post-stabilization service rules
Reference Links:
http://www.dfs.ny.gov, http://www.cms.gov/nosurprises/consumers
Description:
Government-issued guidance outlining legal protections for patients against unexpected medical charges when receiving emergency or out-of-network care, detailing billing rules and cost-sharing responsibilities.
Year:
2023
Region / City:
United States
Topic:
Health Data Collection, Public Health Research, Survey Design
Document Type:
Federal Notice
Agency:
Centers for Disease Control and Prevention (CDC)
Author:
Centers for Disease Control and Prevention (CDC)
Target Audience:
Public, Federal Agencies, Health Researchers
Period of Effect:
Ongoing, with quarterly surveys
Approval Date:
06/30/2022
Modification Date:
Not specified
Year:
2022
Region / City:
Canberra
Topic:
Healthcare billing guidelines
Document Type:
Guideline
Organization / Institution:
Canberra Health Services
Author:
Canberra Health Services
Target Audience:
Clinical and administrative staff
Period of Validity:
Ongoing
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2025
Region / City:
California
Topic:
Specialty Mental Health Services Billing
Document Type:
Manual
Organization / Institution:
Department of Health Care Services (DHCS)
Author:
Department of Health Care Services
Target Audience:
Mental Health Plans (MHP), Billing Vendors, Providers of Specialty Mental Health Services
Effective Period:
SFY 2025-26
Approval Date:
July 2025
Amendment Date:
Not specified
Note:
Year
Theme:
Billing Account Name Change
Document Type:
Instructional Guide
Organization / Institution:
Microsoft
Target Audience:
Microsoft customers requesting Billing Account name changes
Year:
2023
Region / City:
Massachusetts
Topic:
Intensive Community Services, Billing Procedures
Document Type:
Guidelines
Organization / Institution:
Massachusetts Department of Mental Health
Author:
Massachusetts Department of Mental Health
Target Audience:
Service Providers
Period of Validity:
Ongoing
Approval Date:
6/14/23
Date of Changes:
Not specified
Program:
Home and Community-based Services (HCS)
Document type:
Billing requirements
Governing body:
Health and Human Services Commission
Jurisdiction:
Texas
Legal basis:
40 TAC §9.170
Provider obligations:
Service claim preparation and submission
Effective dates:
January 1, 2023; March 1, 2023; November 15, 2019; September 1, 2021
Revision identifiers:
Revision 19-1; Revision 21-3; Revision 23-1; Revision 23-2
Service components covered:
Professional therapies, residential assistance, respite, nursing, employment services, adaptive aids, home modifications, dental treatment, transition assistance
Compliance oversight:
Provider Fiscal Compliance Reviews
Appendices included:
Provider Fiscal Compliance Review Protocol, forms, revisions, contact information
Year:
2022
Region / City:
Victoria, Australia
Topic:
Healthcare policy, Medicare billing
Document type:
Policy guidelines
Agency / Institution:
Department of Health, Victorian Government
Author:
Victorian Department of Health
Target audience:
Public hospitals, health practitioners, hospital administrators
Effective period:
Ongoing
Approval date:
July 2022
Revision history:
Not specified