The new No Surprises Act came into play on January 1, 2022. The federal act covers all states and is meant to supplement other state-specific patient protection laws.
But what does the No Surprises Act regulations entail, and what are the implications to patients and your practice?
This article will examine the essential information you need to know and how the No Surprises Act impacts patient care and small to medium medical practices across the U.S.
What is the No Surprises Act?
The No Surprises Act (NSA) entails new federal protection measures to shield patients from surprise medical bills and took effect on the first day of the year in 2022.
The NSA provides new billing protections for emergency and non-emergency care from both out-of and in-network providers. Air ambulance services from out-of-network providers are also included.
So, in short, the NSA aims to protect consumers from surprise bills arising from medical care.
What are surprise bills?
Surprise bills are also generally known as balance bills. Before the NSA, if a patient received care from an out-of-network provider or facility, the health plan might not have covered the entire out-of-network cost. The out-of-network provider or facility would then bill the patient for the difference between the cost of care and the amount received from the claim.
This unexpected balance bill is also known as a surprise bill, and the NSA aims to protect people from this.
According to recent studies, at least one out of five people received surprise bills after emergency care. It is no wonder that eight of ten respondents supported the passing of legislation such as the NSA. Prior to the passing of the NSA, the federal government estimated that the act would affect about 10 million out-of-network surprise bills annually.
How do patients benefit from the No Surprises Act?
The NSA aims to protect patients from out-of-pocket costs, in other words, protections against surprise medical bills. Emergency services without prior authorization are also covered. This applies to both in-network and out-of-network providers.
It often happened in the past during emergency care, where a patient ended up in an in-network medical care facility but received care from an out-of-network provider. Mostly, patients would not be aware and then got caught by surprise when the bill arrived later.
So firstly, there are now bans on certain out-of-network charges on balance bills for certain services like anesthesiology and radiology when visiting an in-network facility. Post-stabilization care is also considered to be emergency care until the physician decides it is safe to move a patient to an in-network facility. It is also required that the patient is given written notice and that the patient gives written consent before they can be moved to another facility.
Secondly, limitations are placed on out-of-network cost-sharing for most emergency and non-emergency services. Patients can’t be charged more than in-network cost-sharing.
Third, the NSA requires that the onus is on the provider or facility to give the patient easy-to-understand information about the billing protections, who to contact if protections were violated, and get consent from the patient before being balanced billed by an out-of-service provider.
For those patients without a health insurance plan who pays out of pocket, known as self-paying, the NSA ensures that patients get good faith estimates, informing them of costs before receiving medical care. If the bill is $400 more than the good faith estimate, patients can file a dispute within 120 days of receiving the invoice.
How does the NSA affect medical providers and facilities?
The NSA isn’t just a guideline for good medical practice guidelines. It is a law, and just like any other law, breaking it carries penalties. For instance, if providers charge patients more than the in-house cost-sharing amount for services covered by the NSA, providers could receive penalties of up to $10,000 per violation.
Providers need to inquire about the patient’s insurance status and inform them if they are adequately covered. In emergencies, following the NSA, providers must now first inquire about the patient’s insurance plan and status and then submit the out-of-network bill directly to the health plan, unlike before when the bill was sent to the patient.
Health plans must respond in 30 days to notify out-of-network-providers of the applicable in-network cost-sharing amount. The medical plan will then inform the patient and explain the amount the patient owes the provider. Only after that can the out-of-network provider bill the patient.
Although patients can waive their rights under the NSA to obtain medical service, providers are not allowed to ask patients to waiver their rights for emergency and non-emergency care.
Another requirement for providers is that their directories are up to date and verified.
- Verification of a provider’s office location, phone number, digital contact information such as email, and business hours are required every 90 days.
- Verification of who is doing what in which location is required every 90 days. In other words, businesses need to verify the physicians, their specialties, and where they are seeing patients.
- Online directories must be updated within 2 business days after any changes occur.
How can Neolytix assist with NSA compliance?
Neolytix is a Management Service Organization that has been working closely with small and medium-sized medical practices for over a decade, providing an a la carte service to practices nationwide.
As we explained in this article, the NSA impacts various processes within your practice, not just billing. With Neolytix’s end-to-end solutions, we are able to make sure your transition and ongoing compliance with the NSA goes smoothly and prevent penalties.
Our expert teams are trained and constantly upskilled to understand and master new legislation that impacts small and medium practices over the USA. We offer stand-alone services in whichever part of your operation you need help, or integrated services covering almost all the administrative and marketing processes in your practice.
To provide an example, the first place where the NSA has an impact on your practice and patient care during the scheduling of appointments. As we discussed earlier, the onus is now on the provider and facility to ensure that the patient is adequately covered and informed of any shortcomings.
Our virtual assistant (VA) teams can handle this process and ensure that you tick off all the boxes that the NSA placed before you. Our teams can also teach and upskill your other staff if necessary and make sure that directories are updated and verified when required by the NSA.
Integrating our billing teams with virtual assistant teams is a sure way to ensure that you have all the facets of your practice covered.
Allow us to take care of compliance and free you from stress, possible penalties, and reputational damage so that you can focus on continuing to provide excellent medical care, like you always have, even before the No Surprises Act.
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