It’s a complicated law that aims to simplify. The No Surprises Act is intended to increase transparency in healthcare and lead to fewer unexpected bills for patients.
Congress passed the No Surprises Act at the end of 2020 with bipartisan support as part of the Consolidated Provisions Act of 2021. Most of the law’s provisions will take effect on Jan. 1, 2022.
Purpose of the No Surprises Act
Surprise billing laws in most states apply only to insurance plans regulated by their respective state departments of insurance. They don’t touch self-funded, or Employee Retirement Income Security Act (ERISA), plans. The No Surprises Act closes that gap.
As Henry Casale, partner at Horty Springer, explains: “The No Surprises Act applies when a patient who is seeking care at a hospital that participates in a patient’s health program receives treatment (emergency and/or non-emergency) from a non-participating physician. When this occurs, and absent notice and consent, the non-participating physician’s claims for services rendered must be in accordance with what is allowable under the No Surprises Act and its regulations. For hospitals, this new obligation places a premium on, and generates an incentive to get as many providers on the hospital’s medical staff as possible to participate in the same insurance programs as the hospital.”
The Departments of Health and Human Services (HHS), Labor, and Treasury issued an interim final rule providing details on several aspects of the law. While a delay on enforcing certain provisions has been announced as the departments continue working on additional rules, there are measures your organization can take now to prepare.
Identify the right internal players
Mary Paterni, associate attorney at Horty Springer, recommends beginning a compliance assessment by reviewing your hospital’s agreements with each of its physicians and physician groups. She notes, however, that most hospitals don’t have agreements with all the physicians appointed to their medical staff, which means the possibility for surprise bills will still exist.
“In anticipation of this, the surprise billing rules require each health care provider and facility to make publicly available, post on a public web site, and provide disclosure notice to each patient who is enrolled in a health plan and is treated at the hospital, information pertaining to the protections against balance billing provided by the No Surprises Act,” Paterni explains.
She recommends using the Model Disclosure Notice published by the Centers for Medicare & Medicaid Services (CMS).
Hospitals should prioritize areas that will be most affected by process changes, including registration and scheduling staff who will need to provide patients with a new form to sign. Billing and claims processing staff may need to add new language on billing statements around, for example, the process for disputing a bill.
Develop No Surprises Act policies and educate
It’s critical to have policies in place to demonstrate how you’ll comply with the new requirements. These policies need to keep in mind that these rules authorize HHS to impose civil monetary penalties against non-compliant providers.
Casale notes: “Compliance officers will need to stay on top of these regulations, be sure that the hospital is collecting the documentation that CMS wants to see in order to demonstrate compliance with the No Surprises Act, and in doing so, protect their hospitals from the threat of civil monetary penalties.”
Education and communications are also key. Develop scripts and FAQs for front-line staff who interact with patients. Also, ensure that leadership is aware of the upcoming changes. Your CEO should be up to speed on the new law and its implications for your organization. Likewise, your CFO should recognize the financial impact of the regulations and how they will impact billing, statements and required notices.
Testing and validation are crucial too. Verify that the forms are loaded into your system and that any notices required to be posted in the office are appropriately displayed.
For model procedures, policies, and expert tools specific to provisions of the No Surprises Act already in place, YouCompli offers practical tools to simplify compliance.
Begin your compliance assessment now to prepare for providing greater transparency in 2022. The fewer surprises in healthcare, the better.
How is your healthcare organization keeping up with new regulations like the No Surprises Act and other pending changes? Read more about our regulatory monitoring process or schedule a demo.
Jerry Shafran is the founder of YouCompli.