No surprise billing: No Surprises Act effective Jan. 1, 2022
Requirements
In order for organizations and health plans to be compliant the following guidelines must be met:
- The new rule must be made public on an organization’s website
- A one-page notice must be sent to patients via hard copy or email
- Directions on how to contact state and federal agencies about potential billing violations must be included on the website and notice
Furthermore, operational changes to workflows will be needed along with these requirements in order to avoid penalty fines.
Objectives for readiness framework
The following checklist will prepare organizations for the upcoming final rule and ensure NSA compliance:
- Design a pre-service financial clearance process to identify out-of-network patients for scheduled services and the development of consent form
- Assist with a historical analysis of patient volumes and reimbursement for out-of-network emergency room services
- Analyze financial impact
- Ensure billing system claim process is compliant
- Incorporate new requirements into current workflows
Mazars can assist with educating your leadership and executing the readiness framework to allow for a seamless transition into the no surprise billing era. Learn more about how Mazars’ Healthcare Consulting Practice helps.
The information provided here is for general guidance only, and does not constitute the provision of tax advice, accounting services, investment advice, legal advice, or professional consulting of any kind. The information provided herein should not be used as a substitute for consultation with professional tax, accounting, legal or other competent advisers.