H.R. 8684: Transparency in Billing Act of 2026

The Transparency in Billing Act of 2026 amends the Employee Retirement Income Security Act of 1974 to enhance the accuracy and transparency of hospital billing practices. It establishes new requirements for group health plans and health insurance issuers regarding claims from hospitals for outpatient services. Here are the main points of the bill:

1. Honest Billing Requirements

This bill requires hospitals to use a unique health identifier when submitting claims for items and services provided at off-campus outpatient departments. Specifically, claims submitted by hospitals must include this identifier in order to be eligible for payment by group health plans. This aims to ensure that billing is accurate and represents the specific service location.

2. Definition of Off-Campus Outpatient Department

The bill defines an "off-campus outpatient department" as a facility that is not located on the main campus of a hospital or within a designated distance from hospital premises. This definition helps clarify which services fall under the new billing requirements.

3. Reporting Violations

The bill mandates the establishment of a system for individuals to report suspected violations of these billing requirements. The Secretary of Labor is tasked with creating this reporting process within one year of the bill's enactment.

4. Enforcement Mechanisms

The bill introduces penalties for hospitals that violate billing requirements. Smaller hospitals (with 30 beds or fewer) could be fined up to $300 per day for ongoing violations, while larger hospitals may face penalties of up to $5,500 per day for the same.

5. Implementation Timeline

These new billing requirements will take effect starting January 1, 2027, giving hospitals and health plans time to adjust their processes to comply with the law.

6. Rulemaking by Secretary

The Secretary of Labor is responsible for implementing these new amendments through the establishment of rules and regulations.

Relevant Companies

• UHS (Universal Health Services Inc.) - As a large hospital management company, UHS may need to update billing practices and systems to comply with the new requirements.
• HCA (HCA Healthcare Inc.) - Being a major healthcare provider, HCA could be significantly impacted due to the need for adjustments in their outpatient billing operations.