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In December 2020, Congress passed the No Surprise Act, a bill intended to protect healthcare consumers from unexpected medical bills.
This legislation will require adjustment of both front and back-end healthcare provider business operations. Like all of the more recent healthcare regulatory mandates, successful implementation of the No Surprise Act will require careful planning and monitoring to avoid penalties and ensure patient satisfaction.
The No Surprise Act has been in Congress for almost two years. HealthAffairs cited the rising cost of healthcare amid a pandemic atmosphere as important to the final enactment of this bill.
The bill is focused on the common practice of balance billing—when healthcare providers issue statements to patients for costs or services that are not covered by patients’ insurance. Most often these charges arise when care is received from an out-of-network provider, many times without the patient’s knowledge or consent.
The Act prohibits providers, facilities, and health insurance companies from “billing plan holders more than the median in-network rate for non-emergency services provided by out-of-network providers at in-network facilities.” Charges that fall under this restriction apply to covered emergency as well as certain non-emergency services.
Along with the balance billing restrictions, the No Surprise Act expands some elements of price transparency. It requires insurers to provide additional documentation like an Advanced Explanation of Benefits. Also, DHHS will provide grant money to states for publishing a database of claims and payment information from insurers.
The No Surprise Act goes into effect January 1, 2022. This gives healthcare providers a little less than a year to prepare. Most of those preparations will entail reviews and updates of consent forms. However, some tasks may consume additional resources such as creating new front-end revenue cycle processes and educating business office personnel about the new regulation.
This landmark healthcare legislation is one more regulatory directive toward a more consumer-driven industry offering additional protections to patients. Adapting to such directives will be essential to the future business success of both providers and payors as consumer-friendly healthcare participants as well as in avoiding costly penalties of up to $10,000 per violation.
As we move closer to the effective date of January 1, 2022, MEDHOST will continue to keep our customers aware of the latest No Surprise Act developments and will focus on possible system changes to aide compliance. Many customers may need to update their forms to comply with this bill. MEDHOST can offer services for updating or creating new consent forms.
To learn more about how MEDHOST can help you and your team ensure compliance to new billing regulations, or simply add efficiency into revenue cycle management, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.
