No Surprises Act – What Does it Mean for You and Your Practice?
The No Surprises Act (NSA) is a piece of legislation Congress passed in December 2020. It aims to protect patients from unexpected medical bills and ensures that patients know in advance what their healthcare costs will be. As a practice, it's important to understand how this new law affects you and your patients. In this blog post, we'll explain the key aspects of the No Surprises Act, what it means for you and your practice, and how you can ensure compliance.
What is the No Surprises Act?
The No Surprises Act is a law that seeks to protect patients from unexpected healthcare costs. It requires out-of-network providers to charge the same in-network rate for services received by a patient in an in-network facility. This law is set to go into effect on January 1, 2022, and aims to reduce the financial burden and surprise medical bills for patients.
How will the No Surprises Act affect your medical practice?
The No Surprises Act will have a wide-reaching effect on your medical practice. It will limit the ability of out-of-network providers to bill surprise charges to emergency and non-emergency patients who receive services at an in-network facility. Additionally, out-of-network providers must inform patients of their out-of-network status 72 hours before providing services. These requirements may affect the types of procedures you can offer as an out-of-network provider and the amount you can charge for those services. Finally, it will also limit insurer reimbursement for certain emergency services. Ultimately, it is important to understand the implications of the No Surprises Act and adjust your practice accordingly to remain competitive in today's healthcare landscape.
In addition to this, the Act also:
An independent dispute resolution procedure is provided to determine out-of-network charges between health providers and plans. This also applies to providers of air ambulance services.
It creates an avenue to appeal decisions under a health plan that requires estimates of medical services provided to uninsured patients or those paying personally and allows for a dispute resolution process between uninsured patients and a provider on amounts payable in specific circumstances.
What are some ways you can prepare for the No Surprises Act?
Understand the specifics of the No Surprises Act. Ensure you know all its clauses and provisions to make informed decisions on behalf of your practice.
Re-evaluate your network participation and payment arrangements. Determine whether you should become part of a larger network or seek other alternative payment arrangements.
Reach out to insurers and discuss reimbursement policies and contracts. Get in touch with insurers in your area to ensure that you are getting the best deal for your services.
Consider arbitration as a dispute resolution option. As arbitration requires time and money, consider opting only if the case is financially viable for your practice.
Utilize patient advocacy services. Patient advocacy services can be helpful when it comes to an understanding different reimbursement arrangements and navigating the complexities of the healthcare system.
Partner with other providers or organizations. You may want to partner with other physicians, hospitals, or healthcare organizations to increase bargaining power and negotiate better payment rates.
By taking the time to understand the No Surprises Act and by making the right preparations, you can help protect yourself and your practice from unexpected financial losses caused by surprise billing.
Are there any other laws or regulations you need to be aware of?
Healthcare professionals should be aware of a few other laws and regulations. The first is the Affordable Care Act (ACA). This act requires that individuals and employers purchase health insurance coverage or face financial penalties. It also provides subsidies to lower-income families and individuals.
Additionally, the Stark Law prohibits self-referrals by physicians. Self-referrals are any referrals made to medical facilities owned in part or entirely by the physician.
Finally, the Anti-Kickback Statute prohibits compensation in exchange for services or referrals. This law aims to prevent fraud, bribery, and other illegal activities.
As a healthcare professional, you must stay up-to-date on all laws and regulations governing your practice. Understanding the intricacies of these laws will help ensure you stay compliant with all applicable statutes and regulations.