No Surprises Act Part 2: How Providers Can Achieve Compliance

In our last piece, we examined the No Surprises Act, which protects patients with private health insurance from receiving surprise medical bills for services they unknowingly rendered from out-of-network providers. While this regulation is a big win for patients, providers may face challenges adapting to the new regulations. In this piece, we’ll examine how providers can best comply with the new regulation and protect their interests.

In order to remain compliant with the No Surprises Act, providers will need to be able to provide a “Good Faith Estimate” to out-of-network patients that align with regular in-network contracted rates. Providers can also work to achieve in-network status with a majority of large regional payers. Providers who successfully negotiate agreements with a majority of regional payers insulate themselves from potential fines for noncompliance.

It will be imperative for providers and facilities to educate front desk staff, billing staff, and contracting staff on the No Surprises Act guidelines. This may be a single employee for small practices or an entire staff for larger systems. Providers will need to rely on educated staff members to navigate existing requirements, stay up-to-date on emerging rules and regulations, and protect the agency from becoming non-compliant.

Healthcare providers will not only need to educate their staff on regulations, but they must also train them to have disclosure discussions with beneficiaries seeking services from non-participating providers. Patient notification requirements don’t just end with verbal disclosures. New regulations also require the No Surprises Act information to be posted publicly in their facilities, as well as on their website. Prominent, patient-facing communication about these new regulations can prevent a problematic billing scenario or patient dispute.

The No Surprises Act establishes several new guidelines and requirements for providers with the goal of preventing out-of-network billing disputes between non-par providers and the patients they serve. In order to achieve the highest levels of compliance, providers are encouraged to grow their contracted payer network, establish dedicated and knowledgeable employees, implement systems and processes to prevent accidental balance billing, and rely on strong patient-provider communication strategies. These steps will allow providers to continue to provide quality care and avoid patient dissatisfaction or billing disputes.

References:

Ending Surprise Medical Bills

No Surprises: Understand your rights against surprise medical bills

No Surprises Act Implementation: What to Expect in 2022

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