Expert-informed tips on staying compliant under No Surprises

What’s at stake for healthcare organizations under No Surprises

The No Surprises Billing Act was designed to protect consumers from unexpected medical bills from out-of-network providers, out-of-network facilities, and out-of-network air ambulance providers.

Even amongst the insured, surprise bills are commonplace in the United States. In fact, a study conducted in 2020 found that 1 in 5 insured adults reported that they have received an unexpected medical bill from an out-of-network provider

Here’s a common surprise billing scenario: A patient may be in an in-network organization but receive treatment from an out-of-network doctor. They’re typically not aware that they are receiving out-of-network services until they receive the bill.

Now, providers will be required to work out the payment aspects of the out-of-network situation. Like Reg F, these new changes leave healthcare organizations vulnerable to potential loss of revenue, risk of litigation, and heavier administrative workloads.

To remain compliant with the No Surprises Act, healthcare organizations must make some adjustments. One adjustment under No Surprises is the detailed notices that must be provided to the patient.

Notice requirements under No Surprises

Under the new law, out-of-network providers must provide written notice of the costs within 72 hours of the item or service being delivered and obtain consent from the patient. The notice also must be made available in the 15 most common languages spoken in the provider’s area. At a minimum, this new notice must contain:

• Notification that the provider is out-of-network
• A good faith estimate of the charges that will be incurred for the item or service
• A list of in-network providers at the facility (if the facility is in-network)
• Information on prior authorization or other care-management requirements
• A clear statement that consent is optional and that the patient can choose an in-network provider instead if they wish

For out-of-network healthcare providers delivering services at an in-network facility for the patient, the organization—not the provider—is responsible for maintaining these consent documents, and records of notice and consent must be retained for seven years after the date of service. Because of this, your revenue cycle manager needs to have robust record-keeping measures in place.

Related: What healthcare organizations need to know about Reg F and No Surprises.

Simple tips for staying compliant under No Surprises

Here are some tips, straight from our compliance experts, on best practices under No Surprises.

1. Shift your billing point of contact.
   Your healthcare organization needs to adjust its billing processes so that the insurance provider, not your patient, is the first point of contact for an outstanding balance.
2. Build new payer relationships.
   Patients are largely removed from the medical billing process, so your organization must create relationships with a variety of new payer organizations. Because each health plan has its own compliance and claims submission processes, you must quickly learn these processes to ensure they get paid for services as quickly as possible.

Want more tips about staying compliant under No Surprises? View our webinar.