The No Surprises Act, which went into effect on January 1, 2022, is designed to protect patients from unexpected medical bills resulting from out-of-network care. While this legislation is a step towards ensuring transparency in medical billing, it poses some challenges for healthcare providers. To avoid potential financial and reputational harm, it is important for medical practices to prepare for the No Surprises Act.

What is the No Surprises Act?

The No Surprises Act prohibits balance billing, which is the practice of billing patients for the difference between what a provider charges and what the insurer pays for out-of-network care. It also establishes a dispute resolution process to determine payment for out-of-network services based on a benchmark payment rate. The Act applies to emergency services, non-emergency services provided by out-of-network providers at in-network facilities, and air ambulance services.

Is your practice affected by the No Surprises Act?

The No Surprises Act applies to all healthcare providers that bill for out-of-network services. This includes hospitals, physician groups, laboratories, imaging centers, and other healthcare facilities.

How can your practice prepare for the No Surprises Act?

1. Check your contracts with insurers

Review your contracts with insurers to ensure that they comply with the No Surprises Act. Make sure you understand the terms and conditions of your contract and how they affect your billing practices.

2. Update your billing practices

Update your billing practices to comply with the No Surprises Act. This may involve changing your policies for collecting payment from patients or updating your billing software.

3. Educate your staff

Educate your staff on the No Surprises Act and how it affects your practice. Train your staff on how to communicate with patients about their insurance coverage and any potential out-of-network costs before providing care.

4. Prepare for the dispute resolution process

Prepare for the dispute resolution process by understanding how it works and what documentation you need to provide. Consider working with a third-party dispute resolution organization to streamline the process.

5. Communicate with patients

Communicate with your patients about their insurance coverage and any potential out-of-network costs before providing care. Make sure patients understand their rights and obligations under the No Surprises Act.

Conclusion

The No Surprises Act is an important piece of legislation that protects patients from unexpected medical bills resulting from out-of-network care. Medical practices must prepare for the Act to ensure compliance with the law and avoid potential financial and reputational harm. By checking contracts with insurers, updating billing practices, educating staff, preparing for dispute resolution, and communicating with patients, medical practices can be prepared for the No Surprises Act.