In July 2021, the Department of Health and Human Services, the Office of Personnel Management, the Department of Treasury, and the Department of Labor released an interim final rule with comment period to implement the No Surprises Act, which goes into effect in January 2022.
The No Surprises Act protects insured patients from unknowingly receiving surprise medical bills from out-of-network providers or facilities in a variety of emergency and non-emergency settings. To ensure compliance with the new rule, healthcare leaders within the revenue cycle must familiarize themselves with the requirements and ensure processes are in place to uphold each component of the law.
Under the No Surprises Act, insurance plans will be required to cover emergency care when it is provided to plan members by:
In addition, insurance plans will be required to cover non-emergent care provided by out-of-network providers or facilities unless patients are provided with proper Notice and Consent as outlined in the rule.
In all of the above scenarios, the patient may not be held responsible for an amount that “exceeds the cost-sharing requirement for such services”. Providers may not balance bill patients for more than this amount.
When Notice and Consent Requirements are met, however, out-of-network providers and facilities may charge patients for non-emergent or post-stabilization care.
Because the primary focus of the No Surprises Act is to protect patients from unknowingly receiving surprise medical bills, providers will be allowed to charge patients for non-emergency care provided by out-of-network providers and/or facilities when certain conditions are met:
According to the law, providers may not balance bill patients for any of the following ancillary services, to which the Notice and Consent exception does not apply—
Providers are also prohibited from balance billing when unforeseen, urgent medical needs arise during the provision of a service for which a provider obtained consent.
It’s time to assemble a team charged with accountability for planning and implementing the necessary changes. These individuals should be knowledgeable about the new law and remain up to date with any subsequent regulatory updates or legislation.
Once familiar with the law, this team may begin analyzing how current revenue cycle processes can be updated to fulfill the law’s requirements. For example, their to-do list may include items like:
The information above is a great jumping-off point for your organization’s efforts in this area, however it is not exhaustive. Be sure to read the law carefully and in its entirety while working closely with revenue cycle partners like OS, inc. and efficientC. While we are not a legal entity or authority, we are here to help and look forward to working with our clients as they navigate the new requirements.
If you if have questions or need any assistance, feel free to reach out to us here.
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