Inbox Health hosted a webinar on October 21, 2021, titled, “No Surprises Act: What Healthcare Professionals Need to Know.” The law, set to go into effect January 1, 2022, protects patients from unexpected medical bills. Dr. Jack Hoadley, Research Professor Emeritus in the Health Policy Institute of Georgetown University’s McCourt School of Public Policy, shared expert insight on how this law impacts medical billing. Here are four ways billing teams will be impacted and what you can do now to prepare:
Bills from out-of-network providers will be handled differently than they are today. Previously, the responsibility fell on the patient to move the payment process forward with the insurer. Now, it will be the responsibility of the biller to communicate with the patient’s insurer. Sending a larger balance bill to a patient is illegal. Before billers send statements to patients, they need to communicate with the insurer and confirm notice and consent were received.
Billers will be responsible for ensuring new notice and disclosure requirements are in effect. For example, notice of No Surprises Act protections must be posted on provider’s websites and on EOBs for out-of-network care. A patient is able to waive his right to be protected from large out-of-network bills. However, a notice and consent waiver must be signed at least 72 hours before care is provided in most cases. It will be important for billers to know when notice for out-of-network care has been provided and when a patient has consented. This information dictates when billers can send a full out-of-network bill to a patient.
Billers may become involved in the negotiation and independent dispute resolution (IDR) process. If negotiations fail between the insurer and provider, either entity can request arbitration done by IDR. Billers will be required to know the outcomes of negotiations to determine the appropriate payment amount to send to a patient.
Billers will play a role in compliance. Billing teams have an opportunity to position themselves as experts. Penalty for noncompliance is up to $10,000 per violation. Providers will expect billing teams to be the ones who understand the law and become leaders in education and compliance.
Interested in learning more about the No Surprises Act?