By Devin Partida, Editor-in-Chief, ReHack.com
Twitter: @rehackmagazine
In January 2022, a new law implementing additional protections against surprise medical bills will go into effect.
The “No Surprises Act” (or NSA) was passed by Congress in 2020 as part of the year-end omnibus spending bill and may have serious implications for healthcare providers.
Surprise Billing and New Consumer Protections
Healthcare research has found that one in five emergency room visits and one in 10 elective surgeries can result in a potential surprise out-of-network bill. Around one in six commercially insured adults has had one of these surprise bills, and two-thirds of adults are worried about affording unforeseen medical expenses.
These surprise bills may make it much harder for healthcare organizations to provide care. There’s some evidence that fear of surprise billing has pushed consumers to avoid necessary medical care — even when that care is completely free.
For example, some Americans postponed receiving immunization for COVID-19 due to fears that they would be billed for the vaccine after the fact.
Strain on medical facilities can also increase the likelihood that patients will be provided care by out-of-network healthcare workers — potentially resulting in a surprise bill. During the pandemic, as healthcare providers struggled to keep up with patient demand, surprise billing made it even more challenging to offer care.
How the NSA Will Work
According to a legal analysis of the act by health lawyer Kelly J. Noyes, the No Surprises Act intends to prevent these bills by imposing certain requirements on healthcare facilities, providers, insurers, and group health plans that offer services or provide coverage in one or more of three major healthcare areas:
- Emergency services
- Non-emergency services provided by out-of-network providers at in-network facilities
- Air ambulance services
Under the act, health plans that offer emergency coverage must provide it without prior authorization and without regard to whether a facility is in-network or out-of-network. Healthcare facilities also cannot bill patients for out-of-network medical care.
How the No Surprises Act May Impact Providers and Patients
While some doctor groups are pushing HHS to weaken the NSA’s implementation, the department seems ready to defend the act. HHS Secretary Xavier Becerra has said that the department has heard concerns from providers, but believes the bill is necessary to protect consumers.
The biggest winners of the new act will likely be consumers — though providers also stand to benefit. If effective, the act will help to significantly reduce the frequency of surprise billing.
In turn, this could help make providing effective care easier for healthcare organizations — especially in the case of providing emergency care — as the organization won’t have to negotiate with insurers over coverage of certain types of care.
Reducing the risk of surprise billing may make it much easier for healthcare organizations to offer effective care and implement best practices, like patient-centered care or the creation of resources for unhoused patients.
The Congressional Budget Office estimates that the NSA could reduce insurance premium prices by between 0.5% and 1%. Patients may waive NSA protection if they desire, but only in regards to non-emergency medical services.
Out-of-network providers can refuse to provide services to patients that decline to waive NSA protection, but only if there are in-network providers available to provide the service and no other law bars that refusal.
What Healthcare Facilities Should Do Now
While some details of how the act will be implemented are not clear yet, providers can take steps now to ensure they can continue providing care to patients without the risk of disruption.
The NSA, for example, requires healthcare providers to provide a one-page disclosure describing the act in plain language to staff and patients. Organizations should also prepare to stop balance billing out-of-network patients and begin obtaining written waivers from patients who wish to waive their NSA-related rights.
These organizations should also consider in advance how to securely store these waivers in a way that keeps patient information safe, especially as pressure from COVID-19 and its variants continue to put a strain on healthcare cybersecurity teams.
Preparing Healthcare Facilities for the No Surprises Act
When the NSA goes into effect, it will provide new protections for patients seeking care from out-of-network providers. Providers should act now to ensure they’re ready for the new requirements of the NSA.