Just before the start of 2021, the No Surprises Act was passed into law. The purpose of the No Surprises Act is to protect patients from surprise medical bills, especially in situations where patients have little or no control over who provides their care. This includes non-emergency services provided by out-of-network providers at in-network facilities, emergency services provided by out-of-network providers and facilities, and air ambulance services.
For patients, the No Surprises Act is a timely solution for an issue that has historically been a source of frustration. In fact, a recent Harris Poll found that two-thirds of U.S. adults with private health insurance have received an unexpected medical bill, and of those, 1 in 3 were not able to pay the bill with money immediately available to them. Patientco’s 2020 State of the Patient Financial Experience Report emphasizes the frustration patients associate with surprise medical bills. Our survey found that more than 25% of patients would rather have their entire wallet stolen over receiving a surprise medical bill for $500.
The No Surprises Act will benefit the patient experience and ensure greater transparency for patients when it comes to the cost of their care. However, the law will pose unique compliance requirements for health systems.
The Law’s Impact on Health Systems
Beginning in 2022, healthcare providers who are treating patients for emergency services will no longer be able to bill an insured patient for more than in-network rates, even if the services provided are out-of-network. In addition, outside of emergency services, out-of-network providers who are providing healthcare services at in-network facilities will no longer be able to bill an insured patient for more than in-network rates, unless the patient consents at least 72 hours in advance. Patient consent cannot be provided for certain ancillary services, such as anesthesia and radiology, in any circumstances and must be billed at in-network rates. Detailed requirements apply to the notice that must be provided to the patient prior to consent, as well as the consent itself. In 2022, providers will also be required to post on a website a one page notice stating the provider’s compliance obligations under the No Surprises Act, as well as any other similar state laws, and provide contact information for regulators if patients have complaints to bring. Failure to comply with these requirements can result in up to a $10,000 fine per violation.
Separately, health insurers will be required to respond to a health system regarding reimbursement, and therefore patient responsibility, within 30 days of the originally submitted claim. This will have strong downstream implications for patients as they seek to understand their outstanding payment obligations, and health systems can, in turn, more swiftly offer a more compassionate payment experience that builds trust and loyalty.
How We Make it Easier to Comply with the No Surprises Act
At Patientco, we have witnessed the challenges our health system clients have faced over the last 12 months due to the ongoing COVID-19 pandemic, compliance with the new price transparency rule and more. That’s why we are extending the capabilities of our patient financial engagement platform to make it easier for health systems to navigate this latest policy change.
In March 2020, Patientco introduced new COVID-19-related system checks to help identify and suspend bills that would otherwise be sent to patients who had received treatment for COVID-19 and were protected from being billed by rules introduced by payers as well as state and federal agencies. “Patientco’s SmartCommunication platform will intelligently identify patient bills that do not pass specified regulatory, compliance and health system policy checks,” says Sean Joyce, Patientco’s Chief Technology Officer. Patientco is expanding our SmartCommunication technology to help health system clients comply with the No Surprises Act and reduce the likelihood of inadvertently sending balance bills to out-of-network patients that do not meet the new rules.
Built to be Future Proof
Applying these capabilities to support compliance with No Surprises Act is yet another way Patientco’s technology is built to be “future proof.” Our technology is thoughtful in design, architecture, and rich in features that meet health systems and patients where they are, today and tomorrow.
As KLAS recently stated in its 2020 Patient Financial Experience report, Patientco is described as highly engaged in making sure clients succeed and proactively reaches out with offers to help (KLAS Patient Financial Experience 2020 report, page 4). Our ability to empower health systems to swiftly respond to emerging regulatory requirements, such as the No Surprises Act, further demonstrates Patientco’s unwavering focus on our clients’ success.
To read the actual Bill, H.R. 133, go here.