The No Surprises Act has officially been instated, which means providers should be adjusting their billing process as needed for out of network billing. The Act seeks to reduce the amount of surprise bills patients are sent when they receive care from out of network doctors or hospitals that they did not choose or were unaware they were outside of their coverage. According to federal estimates, this law could now apply to almost 10 million bills. Instead of the patient being responsible for the entire balance, it will need to be negotiated between the provider and insurance so that the patient is charged the in-network cost. If the provider and insurance can’t come to an agreement, then it will need to be settled through an independent dispute resolution process. In other words, billers need to be prepared to do more communication with insurance companies in 2022 and beyond and advocate an adequate reimbursement price in those instances.
For doctors or clinics that have chosen not to go with an insurance network previously, they might want to rethink that since the law requires the surprise bills to be settled through arbitration. It cannot be based on local rates but instead median in-network local prices, which means communication with an insurer is necessary.
As we continue into the year, Outsource Receivables Inc. will be keeping a close eye on how this law continues to influence the healthcare industry. Give us a call if all of these healthcare changes have started to affect your billing process and revenue cycle.