Understanding the No Surprises Act of 2022
Healthcare is a complicated industry, and understanding how to accurately bill for services rendered can be rather challenging. The No Surprises Act of 2022 is designed to prevent patients from dealing with surprise medical bills from a variety of medical services. Keep reading to learn more about the No Surprises Act of 2022 and how this law affects the medical billing industry.
What Is the No Surprises Act of 2022?
On January 1, 2022, the Department of Health and Human Services put the No Surprises Act into effect. This federal law protects patients from receiving surprise billing for emergency care, some post-stabilization services, and non-emergency services.
In many cases, surprise billing occurs in cases of emergency when there is not an in-network facility nearby. In these instances, patients must receive emergency care at an out-of-network facility. If their health insurance policy does not cover these out-of-network services, they must pay for them themselves. This can cause the cost of care to skyrocket into tens of thousands of dollars rather quickly.
Surprise billing also frequently occurs when patients go to an in-network facility but receive care from an out-of-network provider. For example, anesthesiologist surprise billing is relatively common—if a surgical team includes an out-of-network anesthesia provider, the patient is responsible for the cost of their healthcare services.
The No Surprises Act of 2022 relieves patients of these unexpected costs and instead places the burden of managing outstanding medical bills on group health plans and provider organizations.
Who Does the No Surprises Act Apply To?
The No Surprises Act aims to create consumer protections from surprise medical bills. To this extent, it applies to patients. However, its provisions also apply to out-of-network healthcare providers, facilities, and payers. Patients receive care from a healthcare provider at their facility, after which a payer ensures the provider is reimbursed for their services and care. In this light, the No Surprises Act of 2022 affects nearly every element of the healthcare industry.
Keeping up with changes in the medical billing and coding industry can be difficult—new technologies, legislation, and procedural updates constantly add new layers of complexity. Explore our blog to learn more about the changes coming in 2023 and how you can prepare for them.
Critical Elements of the No Surprises Act of 2022 for Healthcare Providers
The No Surprises Act of 2022 brought many changes for payer and provider organizations. In many cases, the two are required to share responsibilities. However, there are a few significant provisions in the No Surprises Act that relate specifically to providers, such as:
Disclosure of Balance Billing Protections
The No Surprises Act of 2022 requires that provider organizations make information relating to balance billing publically available. These disclosures must be made available online and within the facility itself. They must disclose federal and state requirements for balance billing, as well as contact information for regulatory agencies in case violations occur.
Notice and Consent
Under the No Surprises Act of 2022, patients can waive their balance billing protections, except in cases where emergency care is required. For non-emergency and post-stabilization services, out-of-network providers must provide written notice of the cost of their healthcare services within 72 hours and obtain patient consent.
The written notice from the out-of-network provider must include the following:
- A notification that they are an out-of-network provider.
- A No Surprises Act good faith estimate that accurately outlines the estimated charges for incurred services or care.
- A list of in-network providers at the facility.
- Prior authorization information.
- A clear statement that consent to waive balance billing protections is optional.
However, there are a few stipulations to waiving protections in non-emergency settings. Providers cannot ask patients to waive their balance billing protections if:
- There is no in-network provider available.
- There are unforeseen, urgent medical needs.
- They require ancillary services.
Air Ambulance Services Bills
Under the No Surprises Act of 2022, air ambulance services cannot balance bill patients for medical transport services. In these instances, patients are only required to pay the in-network cost-sharing amount. In many cases where medical air transport is needed, the patient has little to no choices between in- and out-of-network providers—the No Surprises Act protects them from incurring massive bills from this type of emergency aid.
Dispute Resolution Process
The No Surprises Act of 2022 contains two types of dispute resolution processes, the Independent Dispute Resolution (IDR) process and the patient-provider dispute resolution process. Providers, facilities, and payers use the IDR process to determine how much a payer is required to pay a nonparticipating provider or emergency facility. The patient-provider dispute resolution process should be used by uninsured patients who receive a bill that significantly exceeds the No Surprises Act good faith estimate they received.
Both of these processes provide a methodical approach to navigating billing disputes.
Changes To Medical Billing and Coding
Changes in compliance requirements often reverberate throughout an organization’s revenue cycle management process. Under the No Surprise Billing Act of 2022, patients are only liable for their in-network cost-sharing amount, and healthcare and insurance providers are required to negotiate bills through their own resolution process. This may cause significant changes to the medical billing process, workflow, and reimbursement rates. However, with a reputable medical billing and coding provider, you can easily navigate these changes.
