Patients despise unexpected payments or Surprise bills, and due to the “No Surprises Act,” they can become even less frequent shortly. However, although the bill covers patients, it introduces additional complexities for doctors. In several cases, it transfers the balance of control to private insurance plans and could have a detrimental impact on doctors.
Physicians and their billing workers must become acquainted with the No Surprises Act so that they can adapt appropriately and make sound decisions in the future.
What is the No Surprise Act?
The No Surprises Act is part of the Consolidated Appropriations Act of 2021 (H.R. 133; Division BB – Private Health Insurance and Public Health Provisions) that aims to fix unexpected billing at the federal level. In general, it prohibits American patients from getting “surprise” medical bills as a consequence of coverage shortages with programs such as emergency services and treatment delivered by out-of-network agencies at in-network hospitals, including air ambulances.
The aim is for patients to be kept responsible solely for in-network cost-sharing, leaving hospitals and insurers to negotiate reimbursement. This is where physician reimbursement becomes complicated. In situations of payment conflicts, providers would collaborate with insurers through an Independent Dispute Resolution (IDR) mechanism. The attempt is to promote patient awareness and cost control.
The law went into force in January 2021. These amendments will take effect on January 1, 2022, as it will be unconstitutional to charge patients at prices that are greater than the in-network cost-sharing required by insurance plans — except for field emergency transportation.
How No Surprise Act will impact Physician Billing?
Physicians are always in support of helping and protecting patients from any unanticipated medical bills that might come to the surface when the patient assumes medical cover for a service but the insurer didn’t have the bandwidth to accommodate the needs of the patients.
In such cases, insurers should be liable solely for the cost-sharing amounts that they would have faced if the treatment had been delivered in-network, and these payments should be counted against their in-network out-of-pocket maximums and monthly deductibles.
Physicians might find themselves in a difficult situation, especially in smaller practices. They might lack the resources to take advantage of the IDR mechanism to obtain equal reimbursement. And this comes at a moment when doctors are still facing challenges. Physicians’ sales dropped by 32% on average in 2020 as a consequence of the COVID-19 pandemic. Around the same period, the Congressional Budget Office (CBO) expects that the 2021 Medicare physician reimbursement schedule would result in “significant reductions” in the in-network premiums.
Since the No Surprises Act is fairly new, specifics can emerge over time. Finer points, such as lists of qualifying arbitrators and litigation monetary thresholds, maybe on the horizon and should be taken into account as providers plan for the rule-making process. You could also consult a third-party partner to help you optimize the physician billing systems with a professional medical coding service. Tall RCM your reliable and professional RCM solution provider can help you optimize medical billing. Contact us, to discuss your needs and obtain a befitting solution.