No surprise billing: No Surprises Act effective Jan. 1, 2022

The federal No Surprises Act (“NSA”) will protect participants, beneficiaries, and enrollees in group health plans from surprise medical bills when they receive emergency services, nonemergency services from nonparticipating providers at participating health care facilities, and air ambulance services from nonparticipating providers of air ambulance services, under certain circumstances. Starting January 1, 2022, the No Surprises Act legislation will make it illegal for healthcare providers to balance bill patients for more than the in-network cost-sharing due under the patients’ insurance(s) in almost all scenarios where surprise out-of-network bills arise.

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.

Published on August 19, 2021

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