Preventing Hospital Overbilling of Medicare Act

This bill requires hospitals to bill Medicare and other insurers using separate unique identifiers for off-campus outpatient departments (starting January 1, 2026), rather than treating them as part of the main hospital. It removes exceptions that allowed hospitals to bill higher rates for services at off-campus locations, mandating that these departments use specific billing forms (HIPAA X12 837P or CMS 1500) with their own identifiers. The bill directly affects hospitals operating off-campus departments, Medicare, and health insurance issuers, ensuring claims for these locations are processed accurately. It also directs the National Association of Insurance Commissioners to develop model regulations helping insurers reject improper claims. The key change is standardizing billing to prevent overcharging for off-campus services.