Lower Health Care Costs Act Includes HIM-Relevant Provisions

Lower Health Care Costs Act Includes HIM-Relevant Provisions

This web-exclusive Journal column highlights public policy initiatives at the federal- and state-level that impact the HIM profession, including news on AHIMA’s national and affiliated state advocacy initiatives, Congressional updates, news from federal regulatory agencies, public policy updates from state legislatures, and AHIMA’s public policy initiatives with other organizations.

By Lesley Kadlec, MA, RHIA, CHDA, and Lauren Riplinger, JD


Reducing healthcare costs and increased price transparency is a hot topic on Capitol Hill these days.

Before Congress departed for the Fourth of July district work period last week, the Senate Health, Education, Labor and Pensions (HELP) Committee overwhelmingly passed S. 1895, the Lower Health Care Costs Act out of committee.

Since the beginning of this year, the Senate HELP Committee has held five hearings on how to reduce healthcare costs and four hearings to explore the rising cost of prescription drugs. Prior to the introduction of S. 1895, AHIMA provided comments on a draft of the Lower Health Care Costs Act.

While much of S. 1895 focuses on surprise billing, setting benchmarks for payment, and reducing the cost of prescription drugs, there are a number of key provisions relevant to the HIM professional that are important to pay attention to:

  • Timely billing for patients 1895 requires all healthcare facilities and practitioners to furnish all adjudicated bills to the patient no later than 45 calendar days after discharge or date of visit. In its comments on the original draft of the bill, AHIMA cautioned that claims cannot be released to a payer until coding of the record is complete. A number of factors may impact the amount of time it takes to code the encounter, including the level of completeness of the documentation. Additionally, AHIMA noted that under guidelines from the Centers for Medicare and Medicaid Services, providers have up to 30 days from discharge to complete their records. As a result, coding may not occur until several days after the 30-day record completion date. Because of this, AHIMA recommended that the Committee clarify the language to state that healthcare facilities and practitioners should send all bills to the patient within 30 business days upon adjudication of a claim by the payer and remittance to the provider. Alternatively, AHIMA suggested that the Committee not require a triggering event but instead require facilities and practitioners to send bills to patients within 60 but no more than 90 business days.
  • GAO Study on Privacy and Security Risks of Non-HIPAA-Covered Entities 1895 also requires a study by the US Government Accountability Office (GAO) to better understand existing gaps in privacy and security protections for electronic health information as patients move their information to third parties, such as mobile apps that are not covered by the Health Insurance Portability and Accountability Act (HIPAA), also known as non-HIPAA-covered entities. The study also seeks to identify potential opportunities for improving the privacy and security protections for electronic health information. AHIMA has previously expressed concerns that the existing regulatory landscape lacks sufficient guardrails around non-HIPAA-covered entities to protect the privacy and security of a patient’s electronic health information. Patients may be largely unaware that once they authorize a covered entity and/or business associate to push their health information to a third-party app and such an entity is a non-HIPAA-covered entity, the rights afforded under HIPAA no longer apply. Additionally, patients may be unaware of how a smartphone app intends to use their health information, leaving them at the mercy of an application developer’s terms of service and/or privacy policy unless an act on the part of the application developer meets the “unfair or deceptive acts or practices” standard under the Federal Trade Commission (FTC) Act. In fact, a recent cross-sectional study in JAMA of 36 top-ranked apps for depression and smoking cessation revealed that only 16 apps described secondary uses.1 Eighty-one percent of the 36 apps transmitted data for advertising and marketing purposes to two commercial entities, Google and Facebook, but only 43 percent transmitting data to Google and 50 percent transmitting data to Facebook disclosed this.2 Inclusion of a GAO study will help further identify existing privacy and security risks in the marketplace as well as critical steps that both the public and private sector should take to mitigate such risks while enhancing the access and availability of individually identifiable health information.
  • Patient matching public meeting Finally, S. 1895 calls on the Secretary of Health and Human Services to convene a public meeting to discuss and provide input on patient matching metrics for the purpose of enabling interoperability and the exchange of health information across healthcare organizations. There continues to be no consistent approach to accurately match a patient to their health information. Lack of a consistent and accurate approach to patient matching has hindered the advancement of health information exchange across the care continuum. A 2017 study by the American Hospital Association indicates that 45 percent of large hospitals reported that difficulties in accurately identifying patients across health information technology (health IT) systems limits health information exchange. Accurately identifying patients and matching them to their data is not only essential to coordination of care and a requirement for health system transformation but also a critical and commonsense step Congress could take to help reduce healthcare costs.

The Senate is currently expected to take up the Lower Health Care Costs Act in July. Stay tuned to future Under the Dome columns for more developments as the bill makes its way through Congress.

You can read the AHIMA’s entire letter on the Lower Health Care Costs Act Discussion Draft here: https://bok.ahima.org/PdfView?oid=302770

  1. Huckvale, Kit, John Torous, and Mark E. Larsen. “Assessment of the Data Sharing and Privacy Practices of Smartphone Apps for Depression and Smoking Cessation.” JAMA Network Open2(4): 2019.
  2. Ibid.


Lesley Kadlec (Lesley.Kadlec@ahima.org) is director, policy and state advocacy engagement at AHIMA.

Lauren Riplinger (lauren.riplinger@ahima.org) is vice president of policy and government affairs at AHIMA.

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