Introduction To The No Surprises Act And Its Impact On Physician Billing Services

 Patients hate surprise bills and soon, they’ll be much less common, thanks to the “No Surprises Act” [1]. But while the bill protects patients it adds new complexities for physicians. In many ways, it shifts the balance of power to commercial health plans, something that could work out negatively for physicians.

Physicians and their billing staff should familiarize themselves with the No Surprises Act so that they can respond accordingly and make smart decisions going forward.

What is the No Surprises Act?
The No Surprises Act falls under the Consolidated Appropriations Act of 2021 (H.R. 133; Division BB – Private Health Insurance and Public Health Provisions) and is intended to address surprise billing at the federal level. In general, it protects American patients from receiving “surprise” medical bills that come about as a result of gaps in coverage for services like emergency services and care provided by out-of-network providers at in-network facilities, air ambulances included. The goal is that patients are only held liable for in-network cost sharing, leaving providers and insurers to negotiate reimbursement [2]. This is where the complication arises for physician billing.

Under the bill, providers will work with insurers in an independent dispute resolution (IDR) process in cases where there are disputes about reimbursement. The legislation doesn’t set a benchmark reimbursement amount and requires that both providers and payers support patients in accessing healthcare cost information. If this effort to support patient understanding and management of costs sounds familiar, it should. Hospital price transparency legislation went into effect in January of 2021, and is intended to help patients better understand their responsibilities in settling medical bills.

These changes go into effect January 1, 2022, when it will become illegal to bill patients at rates higher than in-network cost-sharing due under insurance agreements — the only exception being ground ambulance transportation.

Sourceurl=https://www.3genconsulting.com/introduction-to-the-no-surprises-act-and-its-impact-on-physician-billing-services/

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