The No Surprises Act significantly impacts the revenue for out-of-network specialties and primary care. This coming year will be a difficult year for healthcare managers and their executives as they will implement the, “No Surprises Act” into their operations. CMS has provided additional detail on the plan to make the Act more provider friendly.
Federal protections from surprise bills took effect in 2022. Consumers often get unexpected bills from out-of-network providers when they receive care from an in-network hospital, doctor or another provider whom they did not choose to see.
According to Kaiser Foundation, between 9% and 16% of in-network hospitalizations for non-emergency care include a bill from an out-of-network provider (such as anesthesiologists) whom the patient did not choose. This poses financial burdens on consumers when health plans deny out-of-network claims or apply higher out-of-network cost sharing; patients also face balance billing (aka Surprise Billing) from out-of-network providers that have not contracted to accept discounted payment rates from the health plan. The No Surprise Act protects against surprise medical bills by establishing federal requirements.
The law establishes a process for determining surprise medical bill payment amounts, starting with negotiations between insurers and providers. Federal agencies have published regulations and rules to implement the ACA.
Protections will apply to surprise bills for specific types of services provided in certain settings.
- Emergency Services – Your emergency care is protected under federal law and includes screening and stabilizing treatment sought by patients who believe they are experiencing a medical emergency or active labor.
- Emergency stabilization services – Your insurance will cover emergency stabilization services. It won’t be different than if you went to your doctor’s office directly. But, you do have out-of-network healthcare providers in the network who can provide you care as an alternative to treatment at the hospital. You’ll only have to pay coinsurance or copayment for these services.
- Non-emergency services provided at in-network facilities – Your doctor may have made you feel that you have no choice in the type of facility where your health procedure will be done. However, many doctors are out-of-network or don’t take your health plan. With the new regulation, you’ll be able to go to an in-network hospital or other facility and trust that your doctor is also in-network.
The No Surprises Act has significant impacts on the revenue of a Health Care System. It is requiring transparency in billing practices. The coming changes will allow the customer to manage their care in a way that they could not prior. This new transparency is good for American Health Care.
We at Mystaffology have written about additional healthcare rules relating to required coverage for postnatal care within Minnesota.
