The Surprise Bill Law and how it’s going to change the healthcare landscape.

The Surprise Bill Law that comes into effect on April 15^th may just change the way medical practices in New York bill. The problem of outraged patients not settling medical bills is a growing epidemic and far outnumbers all other consumer complaints made to health consumer assistance agencies.

The law will prevent out of network providers from balance billing patients. It is aimed at protecting consumers from receiving enormous medical bills and pay balance amounts that they were not even aware of.

From different standpoints

Like the cult classic Rashomon, looking at the law from different perspectives, will help better understand the impact that it’s going to have across the care continuum.

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From the patient’s viewpoint:

The law that seeks to protect patients from sticker shock bills will certainly help patients know what their payment responsibilities are. A lot many patients are in the dark about their health plans. And the law makes it mandatory that patients are informed in advance about the cost of their care.

Being treated by out-of-network providers radically alters the bill amount the patient has to settle. Once the law comes into effect, patients will no longer have to shoulder the payment responsibility for unforeseen emergency care or surprise out-of-network care received.

A game-changer for hospitals           

The new healthcare law poses a huge challenge for hospitals. It is now the hospital’s responsibility to educate patients and it can be incredibly uncomfortable to discuss about cost sharing responsibilities in an emergency room setting.

Hospitals will now have to focus more on patient eligibility checks and pay close attention to coverage details and insurance plans. It going to be unbelievably complex as hospitals work with 1300 insurers who offer different plans and coverage.

The law requires a greater deal of transparency. Health centers will have to inform which plans they participate with, the hospital affiliations of the provider, the expected charges and the name and contact details of every healthcare professional who participates in the patient’s care.

There will be a sharp increase in point of service collections. Hospitals will have to clearly inform patients about their medical bill prior to the patient’s appointment. Several medical practices are turning to collections agencies or installing data tools to help them in informing patients their share of payments, beforehand.

Patients will be encouraged to pay throughout the treatment lifecycle. This means patient billing which was one of the revenue streams in a hospital before would soon become the lifeblood of a hospital’s revenue cycle.

The hospital must post on its website the standard charges for services provided.

Nobody wants to hold the data baby!

With so much of information to divulge and educate hospitals feel it is the insurer’s responsibility to educate patients and insurers are keen to shift the responsibility to doctors. Leslie Moran, the VP of the New York Health Plan Association has stated that providers should know which contracts they’ve signed and it would be best for patients to call up their doctors and ask if they’re participating.

A big impact on reimbursement…

Medical practices should now inform patients not just their treatment plans but payment plan as well. And, yes, there will be patients who will flatly refuse to pay. Healthcare professionals will be forced by regulators to collect their dues from patients who can pay but refuse to do so. There will be a concerted effort to improve the patient billing process and collect dues as early as possible. There’s certainly a lot on the plate for insurers.