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The Ultimate Guide to the No Surprises Act 2022

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Getting slapped with unusual hospital bill expenses in the US is no surprise. About two in every three adults are bothered about these unexpected medical bills. The No-Surprises initiative is a regulation in the US healthcare sector aiming to decrease the percentage of patients who are unpleasantly surprised by the bills they receive.

The bill requires ophthalmologists and optometrists, and other healthcare providers, to disclose essential information about estimated costs and provide customized estimates based on what patients want. And it applies when patients get out of the network emergency and non-emergency services or in-network services at a facility without prior notice.

In this current economic environment, “surprise” medical bills are an even greater financial burden than ever, and the no surprise act is here to help patients avoid that hardship. Here’s what your healthcare facility needs to know about the new act.

What are Medical Surprise Bills?

Medical surprise bills have been in existence before the no surprise act was enacted. As mentioned, surprise bills cover the extra amount paid when care is given in out-of-service facilities, even with an insurance cover. Medical surprise bills include emergency services, post-emergency stabilization services, and non-emergency services offered at in-network capacity.

Why Do Patients Need the New Surprise Act?

The current healthcare system is becoming more and more expensive, making it harder for Americans to pay for their medical expenses. In fact, one in five Americans is “underwater” regarding money and health. Many of them have insurance but pay higher deductibles out of pocket—making it almost impossible to afford care from a doctor or hospital.

Provisions in the “new surprises act” protect patients from surprise bills. It outlaws two types of medical care provider contracts: exclusive provider arrangements (when a doctor agrees not to treat anyone else in a health plan’s network). And “balance billing” agreements (when providers charge the patient for any amount above an allowed fee or pay a flat rate when they could or should have charged less).

How to Stay Compliant with the No Surprises Act

One of the benefits of the act to patients is arbitration. It means, in cases of misunderstanding or a bill that’s too much, patients have a chance to dispute. For compliance as a health facility, you need to understand the no surprise act. Here’s how it works:

  • The law forbids clinicians, hospitals, and other providers with insurance from charging patients more than in-network fees for surprise hospital bills.
  • Health plans are required to cover out-of-network statements and allow in-network cost-sharing. And this is for both job-based and non-group intents.
  • NSA offers negotiations between plans and providers to establish a payment process for surprise out-of-network charges. Failure of negotiations causes the involvement of an Independent Dispute Resolution Process (IDP).
  • With health care insurance, providers are required to give an easy-to-understand notice of bill protection with contact details and clear guidelines to understand rights. For instance, in case of surprise billing, a patient must have consented and made inquiries in case of an overcharge.

Penalties for Not Being Compliant

As a health facility, it is vital to stay on the right side of the law to keep off unwarranted penalties. For instance, when a hospital or a health care provider charges patients surprise bills more than the in-network cost-sharing amount, a penalty of $10,000 accrues for every offense.

The penalty is determined by indication of a pattern of violations, lack of provision for credentials of corrective step, and substantial financial damage imposed on health plans or persons.

Medicare and Medicaid, and NSA

The NSA act comes in handy for patients. Even though Medicare and Medicaid have offered guidelines, most of the provisions of this act aren’t clearly written. Therefore, the firm’s healthcare attorney should handle any questions about the act and its applicability, especially for business consulting firms and private practice legal compliance.

Hidden costs for medical care are not new. Even before Obamacare was passed, most citizens have suffered hidden charges. But because your clinic is now conversant with the act, you can stay compliant and avoid mishaps by the government.

You can learn more about it from the experts at Sullivan Management & Consulting Group. We offer up-to-date, detailed information on billing and other healthcare business services. Feel free to contact us with any questions.

author avatar
Brad Petak