Search Results

Publisher/Organization: Center for Advancing Health Policy through Research

Payer: Medicare

Summary: The article argues that a new unique National Provider Identifier (NPI) requirement for off-campus hospital outpatient departments billing under Medicare represents a critical first step for full site-neutral payment reform. The authors argue that the NPI requirement sheds light on hospital billing practices and could help inform efforts to prohibit or curtail anticompetitive practices. While the NPI requirement alone will not end site-based payment disparities, it creates the transparency needed to implement broader reforms.

Topic Areas: Policy Reforms, Site-Neutrality, Billing Transparency

Publisher/Organization: Center on Health Insurance Reforms

Payer: Medicare

Summary: The article examines a 2026 federal law requiring hospitals to use unique National Provider Identifiers (NPIs) for each off-campus hospital outpatient department paid under Medicare. Current billing practices often obscure site of care, limiting the ability of state and federal regulators to enforce facility fee restrictions or implement site-neutral payment policies. The law aims to increase the accuracy of outpatient claims data and transparency on where care is delivered. The authors argue that additional action—such as requiring use of unique NPIs across all payers and improving data systems linking provider locations to parent organizations—would increase the impact of the new policy to the commercial market.

Topic Areas: Policy Reforms, Facility Fees, Billing Transparency

Publisher/Organization: U.S. Public Interest Research Group

Payer: Commercial Insurance

Summary: This report analyzes the growing use of facility fees for hospital outpatient care in the commercial market. It shows that they are applied in settings without hospital-specific resources and can substantially increase charges for preventive care, diagnostic tests, and routine visits without improving quality. These fees raise out-of-pocket costs and insurance premiums. The report highlights how integration has increased physician employment by hospitals, making it harder for patients to avoid settings with facility fees. The report also reviews state legislative actions and proposes policies such as site-neutral payments, unique National Provider Identifiers, facility fee bans for routine outpatient services, and public reporting of facility fee charges and payments.

Topic Areas: Facility Fees, Site-Neutrality, Vertical Integration, Policy Reforms, Billing Transparency