ith the No Surprises Act taking effect in less than four months, it is critical that hospitals and providers leverage technology to ensure patients are informed about their expected care costs prior to receiving services. Despite industry improvements in the last several years, there remains a pressing need for more meaningful price transparency in healthcare. The No Surprises Act, in addition to recent revisions to existing Centers for Medicare and Medicaid Services (CMS) price transparency regulations1 and a policy push by President Biden2, aims to continue the trend toward more patient-centric healthcare that makes it easier for patients to navigate the inherent complexity.
On July 1, the Department of Health & Human Services released the first of three regulations that clarify key portions of the No Surprises Act. In the past, many patients have received unanticipated bills for emergency services or from out-of-network providers who provided services at the patient’s in-network hospital. The No Surprises Act prohibits healthcare facilities and providers who are outside of a patient’s insurance network from “balance billing” except under certain circumstances. For example, under the new requirements, an out-of-network anesthesiologist who participates in surgery or an emergency department physician who cares for a patient may no longer balance bills when these activities occurred at a patient’s in-network hospital. Unless the patient receives notice and provides written consent3, providers may generally only collect cost-sharing amounts that would have been charged had the patient been in-network. This notice and consent process also requires out-of-network hospitals and providers to furnish “good faith estimates” to patients of their expected charges4.
While there are many outstanding questions5 on the No Surprises Act which will need clarification in future regulations, hospitals and providers should not wait to engage key stakeholders to ensure their technology and workflows can accommodate the dynamic nature of price transparency. In addition, while there are provisions for providing notice and consent for balance billing, the notice and consent approach cannot be used in many situations, such as for most emergency services, for defined “ancillary services” and when there are no in-network providers available6. Here are several overarching principles for proactively providing patients with the information they need to make decisions on their care as well as striving to avoid the situations that can lead to surprise medical bills.
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Source: Hitconsultant