The No Surprises Act and the Challenges it Brings

February 17, 2022

The Consolidated Appropriations Act, 2021, was signed into law at the end of 2020 and one significant portion impacting the medical industry is the No Surprises Act (NSA). NSA went into effect January 1, 2022 and applies to emergency services, non-emergency services at in-network facility or ambulatory surgery centers, and air ambulances.

Most everyone would agree medical fees are rising, and at times, it can be difficult to determine how much you will be charged. Surprise billing is also termed balance billing and can occur when patients get care from providers that are out-of-network on their health insurance plan. An out-of-network provider has not agreed with the health insurance provider on a set rate, and therefore bills the patient for the difference. The NSA is staged to reduce “surprise” medical bills to patients. While overwhelmingly seen as a positive leap for consumer rights, providers are now faced with the significant burden of implementing the requirements.

The NSA brings with it some major changes for affected providers. The biggest changes and restrictions relate to:

  • Out-of-network billing
  • Price transparency
  • Disclosure, notice and consent
  • Payment dispute resolutions

Our Take

As providers consider how they will implement the new requirements of the NSA, your revenue cycle process should be of primary importance. Establishing processes to comply and training staff on these processes is clearly the first step. You will need to ask questions such as:

  • Does your staff understand how much insurance companies will pay you for out-of-network services?
  • Are there ways to avoid balance billing situations?
  • Have applicable state laws been considered?

Particular focus will also need to be spent on obtaining pre-authorizations and confirmation of amounts the patient will be billed from the insurance companies. Providers should pay special attention to ensure in-network versus out-of-network status with various insurance companies have been kept up to date. Lastly, time will also need to be spent preparing for any potential dispute resolutions.

Like most new regulations, details are expected to be ironed out and evolve as implementation progresses. Several court cases are already underway, and rulings are expected in the coming months. If you would like to discuss NSA requirements or strategies to improve your revenue cycle, please contact Angela Chaney, CPA at 240.364.2656