No Surprise Act – What’s it all about?

If you have patients covered under group and individual health plans, the No Surprise Act helps them from being charged additionally for both emergency and non-emergency services from network providers not in the scope of the insurance provider but within the in-house network infrastructure and out-of-network ambulance service providers. To understand the dispute resolution process for payment disputes between the insurance plans and providers, the No surprise act establishes an independent process.

This provides new dispute resolution options for people who are uninsured and also self-pay individuals who do not opt for an insurance payout for the medical bills they raise, and the value is substantially greater than the estimate they receive from the provider.

How will be No Surprise Act this 2022?

Rules have changed starting 2022 with new protections coming into application towards the billing system that can help prevent surprise medical bills. Two things to consider with the No Surprise Act- one is if your patients have private life insurance, your patients may find protection bans on most common types of surprise bills. If your patients do not have insurance or you decide not to use their insurance for any service, they can expect a faith estimate of the cost of their availed service upfront.

The bills that your patients claim outside of their insurance provider’s network are sometimes called balance billing. Since these bills are unexpected or Adhoc bills submitted for claiming, they are in turn called a surprise medical bill.

What protections should you keep your patients aware if they have a health insurance?

If your patients come with insurance provided by their employer, these are the new protection rules imposed by the No Surprise Act:

  1. Sanction out-of-network cost-sharing such as coinsurance or copayments for most emergency and some non-emergency medical services availed. Your patients will not be charged more than the cost involved in within network cost-sharing medical services.
  2. Respective healthcare centers and facilities should pass on the appropriate contact person name and details to patients along with explaining the applicable billing protections in a crystal clear manner such that they understand and take it as a pre-notice before submitting their surprise bills.
  3. Approve surprise bills without any pre-authorization even if the health care is out of network provider.
  4. Skip out of the network charges and balance bills for additional services like radiology, anesthesiology if provided by insurance providers out of the eligible network, will be part of your patients’ visit to an in-network facility.

If your patients are charged more than the good faith estimate, then your patients can raise a dispute medical bill if the final charges are $400 more than their good faith estimated amount. The dispute should be registered within 120 days of your bill date.

What protections should you keep your patients are if they are not using insurance or paying out of their pocket?

There may not be protections supporting self-pay for medical services availed by patients where they don’t avail insurance provided by the employer, but they will know prior the estimate of how much to pay along with deductions in amount if any offered by you (healthcare providers) to your patients.

Conclusion:

Surprise medical bills are sometimes painful and difficult for practices to deal with patients who come with such requests. Only insurance providers such as Medicare, Medicaid, and other Indian health services support surprise medical bills from providers and facilities that enable themselves in this program. Therefore, dealing with new rules imposed by No Surprises Act requires an expert’s intervention were communicating with in-network providers and out-of-network providers and getting the medical bills passed without creating any hassle to patients.

24/7 Medical Billing Services is one of the leading medical billing services partners who can help in every nuke and corner of medical billing and make conditions like the No Surprise Act deal effortlessly. Call +1-888-52-0537 today to book an expert’s appointment.

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