No Surprise Act – How Will It Impact US Healthcare?

From January 1, 2022, the No surprise act is going to be implemented in US healthcare. The new law avoids “Surprise” medical bills and insured patients receive out-of-network (OON) care in emergency settings, It will help prevent any additional charges in the billed amount. In the survey from Zelis more than 100 executives representing 85 U.S. healthcare payers

Zelis survey stated the majority of participants are concerned about adhering to the timeline required (64%) and transparency requirements (61%)
And in the same survey mentioned that one-third (41%) have expressed concern over setting the appropriate reimbursement levels, on managing Independent Dispute Resolution process (41%) and transparency in provider directory requirements for the practice(39%)”

Key takeaways of ‘No Suprise Act’

The No Suprise Act protects patients from receiving surprise medical bills during emergency services when visiting an out of network provider
Patients are liable for their in-network cost-sharing amount while providers and insurers have a chance to negotiate reimbursement terms.
Healthcare providers and Insurers can access an independent dispute when the dispute arises. No Benchmark for reimbursement amount.
Both the Provider and Insurance company should be more transparent and assist patients in accessing their healthcare costs.

Independent Dispute Resolution Action	Timeline
Initiate 30-business-day open negotiation period	30 business days, starting on the day of initial payment or notice of denial of payment
Initiate independent dispute resolution process following failed open negotiation	4 business days, starting the business day after the open negotiation period ends
Mutual agreement on certified independent dispute resolution entity selection	3 business days after the independent dispute resolution initiation date
Departments select certified independent dispute resolution entity in the case of no conflict-free selection by parties	6 business days after the independent dispute resolution initiation date
Submit payment offers and additional information to certified independent dispute resolution entity	10 business days after the date of certified independent dispute resolution entity selection
Payment determination made	30 business days after the date of certified independent dispute resolution entity selection
Payment submitted to the applicable party	30 business days after the payment determination

How to choose the right billing partner for your medical practice?

Choosing the right billing partner will help maintain a smooth workflow and improve the cash flow of medical group practice/hospitals. Below are some of the points to be considered while choosing a billing partner

Transparency in reports

Reports provided by the partners should be very precise and should show an overview of the process and where to improve. It should not be overwhelming with clutter and short forms. The more transparent the report are the easier it will be to get the picture and make progress accordingly.

Time taking to implement an update/Change

COVID-19 have accelerated the rate of change in the healthcare industry. Since there are lots of policies amended every year. It is also important for the billing companies to have a strong learning management system(LMS) to share the update immediately.

Business Continuity Plans

Big practices with a huge volume of claims should opt for billing partners who have AR callers in different locations to avoid any business interruptions. Need to check for the flexibility of the operations for effective outsourcing. Work from home is becoming famous during COVID-19, so need to analyze the workflow models adopted by the billing partners. And whether the agents are thoroughly trained under HIPAA to protect the PHI(Protected Health Information)

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Lisa Maciejewski-West
CMC, CMOM, CMIS, MCS-P

“No Surprise Act” How will it impact US healthcare