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The legislative landscape around the healthcare industry changes constantly. Many protections are added or adjusted to ensure patients are getting the best care possible. Keeping up with these new regulations isn’t always easy, though. One piece of legislation that will affect providers in 2022 is the No Surprises Act. This act alters how non-government insurers pay for certain healthcare services. It helps to protect patients from the hidden costs of in-network care. Let’s take a closer look at this act and how it will affect both patients and healthcare providers.
What Is the No Surprises Act?
The No Surprises Act passed in late 2020 as part of the Consolidated Appropriations Act of 2021. It sought to address the issue of “surprise” medical bills when patients receive emergency treatment. This act sets up “guard rails” for patient responsibility. It outlines new regulations for coverage with the goal of preventing hidden healthcare costs for patients.
Why Was the No Surprises Act Passed?
Consider what happens when a patient gets into a car accident. An in-network ambulance transports them to your in-network hospital. A team of physicians then treats them with emergency care protocols. The patient often has an idea of how much they will pay in these cases based on known deductibles and co-pays.
When the insurance company processes the claim, they may discover that a certain specialist is not in-network. Sometimes they deny that claim or reimburse at a lower rate than expected. Then, the non-network specialist bills the patient for the uncovered part of that cost.
For many patients, these bills are a shock because they assumed their insurance covered all treatments. After all, the hospital is in-network with their insurance. It’s these surprise bills, which are often expensive, that this act looks to address.
What Does It Change?
It’s vital to consider how this act applies to patients with insurance and those without (i.e., self-paying patients). For those with insurance plans, there’s a range of ways in which this bill will alter their experience.
It cuts most surprise bills by banning them for many emergency services. This is the case even if specialist treatments are out-of-network and not authorized first. The act states that insurance companies must cover these out-of-network claims and that balance billing is no longer allowed.
This act also bans out-of-network cost sharing for many emergency services. This means that providers cannot charge more than in-network cost sharing for such treatment. Some out-of-network services such as radiology that relate to an in-network visit are no longer eligible for out-of-network charges and balance billing.
The No Surprises Act also requires healthcare providers to give self-paying patients a “good faith” estimate of treatment costs. If their bill is at least $400 more than this estimate, patients can file a dispute within 120 days.
Healthcare providers must provide patients with a simple notice that explains these billing protections. The act requires them to notify patients of who to contact if they have questions or concerns. Notices must also inform patients that these protections always apply unless they consent to waiving them.
*The AHA, AMA, and Texas Medical Association have all filed lawsuits against this act specifically targeting qualified payment amounts (QPAs) and specific language. Arbitration is ongoing, making this an evolving ruling.
How Can We Help?
Credentialing can be a burden for many healthcare providers. Abiding by all current requirements may be confusing, tedious, and frustrating. Luckily, this is where we thrive! We can help your practice adjust to requirements imposed by the No Surprises Act in 2022. If you have questions about how this act will affect you, feel free to contact us or schedule a meeting. We look forward to getting to know your needs and helping you adjust moving forward.