No Surprises Act: How Will It Affect Your Practice?

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No Surprise Act

The No Surprises Act was signed on December 27, 2020, as part of the Consolidated Appropriations Act of 2021. It prevents surprise medical billing at the federal level. The Treasury, Departments of Health and Human Services (HHS), and Labor make the regulations and guidelines that implement many of the Act’s provisions.


Find out how this Act will affect your healthcare practice:


Knowing more about the “No Surprises Act.”

According to American Medical Association (AMA), the No Surprises Act 2022 aims to protect consumers from being blindsided by high healthcare costs, whether unanticipated or emergency. Furthermore, it lays out new processes to improve patient financial protections, enable better transparency regarding costs, and improve provider directories.

Often, patients are shocked when they receive their medical bills because of:

1.Emergency care received at a facility outside of the network,

2. Unanticipated care from out-of-network health care services (from a physician),

3. Or emergency treatment from a physician outside the network at an in-network facility.

All of these means that their care was far more expensive than expected, and they must pay for it. Moreover, the No Surprise Bill law protects against these types of surprise medical bills and lays out how arbitrators will manage disputes between service providers and healthcare plan providers in the future. 

Moreover, the No Surprise Billing Act law protects the patient from surprise medical bills or balance billing and lays out how arbitrators will manage disputes between service providers and health care plan providers in the future. 

As of January 1, 2022, providers for in-network services will no longer be able to charge patients more than the cost-sharing due, except for ground ambulance transport. The Act applies in any situation where a patient might be surprised by an out-of-network bill.

Surprise bills consist of two parts:

  • One of these is the difference between the patient’s designated cost-sharing for out-of-network providers and their designated cost-sharing for in-network providers. For instance, you might pay 10% if the service is in-network and 20% out-of-network.
  • The second component is the difference between the provider’s full charge and the allowed charge negotiated by the insurance company and provider. Surprise medical bills often involve emergency services, but sometimes they also involve non-emergency services.

The provisions of this new law affect physicians, facilities, non-physician health professionals, and health plans, and these requirements take effect at the start of the year 2022.


How will the “No Surprise Act 2022” affect your practice?

Provider directory data

To help insurers maintain up-to-date, accurate directories of their in-network doctors, providers must send regular updates to health plans. The update of the provider directory list also helps to ensure accuracy. Health plans must verify their provider contract status daily and update this information at least once every 90 days. In addition, providers that cannot comply will be removed completely.


Health plans cannot impose a higher cost-sharing amount than in-network rates for patients relying on inaccurate provider information. The provider must refund the patient’s difference in cost with interest if the provider bills the patient for more than the in-network cost-sharing.


Transparency in provider pricing

All out-of-network providers must submit a “good faith estimate” to the health plan detailing all billing and service codes related to the care the patient is expected to receive. Moreover, it determines provider payments for out-of-network services. A three-day period is required to submit the estimates and obtain consent from the patient.


The providers’ websites must post brief content about state regulations related to balance billing. Be sure to provide the appropriate enforcement agency so that the patient can file a complaint.


Does the No Surprises Act affect behavioral health providers, too?

A ban on surprise medical bills may affect behavioral health practitioners working in hospitals and treating out-of-network patients. In particular, this issue is especially relevant for emergency care professionals. As a result, behavioral health providers are only affected by the good-faith cost estimate requirement.

Despite whether you work alone or with a group practice, you must still comply with the cost estimate requirements. Ensure that these estimates are available to all uninsured or self-paying clients. Clients can request an estimate before scheduling any services, and they must receive them before receiving the service.


How Does It Impact Physician Billing?

The No Surprise Bill Act law ensures that out-of-network facilities charge patients the in-network cost-sharing amounts designated by the patient’s health plans. However, the provider may dispute the cost-sharing amount through arbitration.


What does a medical practice need to do to comply with the “No Surprises Act”?

Providers and practices must comply with the following regulations by January 1, 2022:

1.If there are any material changes to the provider directory information, submit them to the plan.

2. Ensure timely delivery of provider directory information to health plans. For instance, healthcare providers must notify health plans when they begin or end network agreements with plans for specific coverage.

3. Prepare to provide information to the plan whenever the Secretary of Health and Human Services (HHS) deems it appropriate. 

The No Surprises Act offers substantial protection for patients and increased transparency about healthcare costs. However, regulatory changes can escalate the administrative burden on a practice.


To guarantee these protections and eliminate cost-of-care burdens on your patients, it is vital that you prepare to implement the Act.


Providing you with the Best

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