The start of 2022 will usher in new legislation from the Department of Health and Human Services (HHS) to protect patients from receiving unforeseen bills from out-of-network (OON) providers. Effective January 1, 2022, the No Surprises Act essentially bans OON providers from billing insured patients an amount greater than if they had been treated by an in-network (INN) provider. As a result, patients will soon be able to avoid surprise fees from OON providers they did not intentionally select.
The issue behind the surprise billing problem is the patient’s lack of ability to definitively choose their provider for certain services. In emergency circumstances, for instance, patients may unexpectedly end up at an OON facility or may be treated by an OON physician out of necessity. Thus, under the new HHS regulations, ED doctors, hospital-based physicians, and providers who deliver emergency care are prohibited from balance billing more than the patient’s INN provider for the same service.
Among other provisions, the No Surprises Act imposes an Independent Dispute Resolution (IDR) process, sometimes called arbitration, to resolve disputes between OON providers and health plans. While the law does not apply to patients who actively choose an OON provider, patients who lack the option to make an informed choice of provider are now protected under the newly established federal standards
Based on these updates from HHS, providers need to reconsider their hospital’s revenue cycle operations strategy. Between clearly identifying network affiliations, clarifying complex medical billing practices, keeping patients fully informed, and organizing appropriate dispute resolution approaches, hospitals have a robust set of criteria to meet before the end of the year, and Savista is here to help. Legal requirements also include readily available notification forms regarding patients’ rights under the bill as well as consent forms for OON providers.
Now is the time to make critical decisions that could impact your bottom line in the future. Balance bills in violation of the No Surprises Act can result in monetary penalties of up to $10,000 per violation. With the new year right around the corner, time is of the essence to ensure compliance for your organization ahead of the updated policy launch on January 1, 2022.
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