The insurance plans allow the in-network patient to get medical care at an affordable rate. However, we have something called balancing bills for every out-of-network service. Healthcare billing services have a middleman role between the insurance companies and providers usually. This occurs more frequently for all in-network patient visits. But in some cases, when providers deal with out-of-network patients, medical billing services act differently. They connect with insurance companies to check whether they want to pay for out-of-network visits. If they refuse to contribute, the medical billing services turn to patients for revenue recovery.
Though, we have familiarity with the underlined objective behind surprise medical bills. Yet, these are additional burdens on OON patients as service fee is relatively higher for such bills. Anyhow, CMS has enacted such alarming bills and forwarded the No Surprise Act to address the issues.
No Surprise Act; Federal Protection of Patient Rights
You might have gotten the basic idea of this federal act for all medical billing services in the US. It was July 1, 2021, when the US Congress passed this law and provided an Interim Final Rule. The Interim Final Rule has been termed as No Surprise Act; Requirements Related to Surprise Billing Part 1. Moreover, CMS has decided to implement it in all medical billing audits and professional services from January 2022.
Patients under a specific insurance program prefer scheduling appointments with in-network providers. This might happen in almost all non-emergency visits. But it is not necessary that you could not approach OON providers in your in-networks visits. There might be some services like anesthesia services that may be performed by any OON provider. In all such cases, the OON service fee is attached to your main bills.
Anyhow, the No Surprise Act safeguards physicians and patients from subsequent problems by taking certain steps;
Non-Emergency Care Medical Billing Services
The OON providers can actively respond to all out-of-network patients without making an excuse. However, they must obey one very simple rule. They must give a notice 72 hours before providing any OON service to patients. With this approach, CMS wanted to consider the patient’s consent for paying such bills. This step will ultimately lessen the revenue delays.
Emergency Care Medical Billing Services
Likewise, nobody is prepared for medical emergencies. If this happens, patients prefer reaching the nearest hospital for getting instant treatment. Thus, no matter whether the patient gets emergency medical care from any in-network or any OON provider, they can never do balance billing.
Air Ambulance/Medical Transport Care Billing Services
For any emergency medical transportation, patients must only pay the in-network cost-sharing.
Other Provisions of the Federal Act 2021
Along with this No Surprise Act also emphasis on some other provisions as well:
For Payer (Insurance Companies)
From January 2022, CMS has asked the insurance companies to revise their summary of benefits and coverage. They must include some additional explanations to address coverage details comprehensively. Alongside, insurance companies will have a limit of 3 business days to provide updated SBC information in written formats.
Providers make agreements with certain insurance companies to give discounted services to patients. However, if the provider’s agreement expires, they will not remain associated with that insurance company anymore. Thus, federal law asks the providers to inform both patients and respective payers. Meanwhile, providers have to give transitional services for 90 days to patients under their supervision till their recovery. During this period, they will offer the same discounted rates for the rendered services to the patients. Thus, all medical billing services have to obey these new rules from now on.
In short, the No Surprise Act benefits the patient by securing them from any financial stresses caused by healthcare billing services by presenting balancing bills for OON services. Meanwhile, CMS has also given special consideration to providers and their reimbursement. If patients will get bills as per their consent, they are more likely to respond to bills and pay them. Medical billing audits confirm how much a healthcare organization suffers from subsequent bad debts due to billing delays by OON patients. Thus, the federal law gives all one solution to reduce bad debts as well.
The recent implementation of the No Surprise Act in medical billing services has been a giant leap forward for Americans seeking access to quality healthcare. This legislation requires hospitals, doctors, and insurance companies to provide clear, affordable and transparent prices for medical services. The act also protects those who receive a surprise medical bill by preventing certain providers from billing patients for services that are out of network.
The aim of this act is to provide Americans with better access to quality healthcare and to give individuals the financial security they need to be able to make informed healthcare decisions. The act requires health plan providers to create a comprehensive list of their contracted providers and give clear prices for non-contracted services. This information must be provided to both in-network and out-of-network patients so they can understand their financial responsibilities prior to receiving their healthcare services.
The No Surprise Act also protects those who receive out-of-network care from surprise medical bills when they can’t access in-network care. It ensures that when individuals do receive out-of-network care, they will only be billed the in-network cost-sharing prices and not the allowed rates. This development is expected to bring much-needed relief to patients who are often charged thousands of dollars in surprise medical bills after receiving medical attention.
The act also safeguards individuals from balance billing, which is when a provider charges a patient the difference between the amount the provider typically charges and the amount the insurance company is willing to pay. This new introduction to medical billing service practices is expected to help drive down healthcare costs for Americans, make healthcare more affordable, and improve overall care quality.
Overall, the implementation of No Surprise Act in medical billing services is a significant move for Americans. It eliminates hidden costs, surprise medical bills, and unaffordable care. This will bring a sense of financial security and peace of mind to individuals as they seek the care they need and empower patients to make more informed healthcare decisions.