No Surprises Act: Five Ways Healthcare Providers Can Ensure Compliance
On January 1, 2022, the federal government implemented the first phases of the No Surprises Act (NSA). This regulation affects most healthcare practices in the United States and dictates that providers can no longer send surprise medical bills for out-of-network expenses or self-pay patients, without prior authorization and a patient signature. To avoid hefty federal government fines, providers must ensure they understand – and fully comply – with this new legislation.
Five ways to ensure your healthcare practice is compliant with the No Surprises Act
The No Surprises Act exists largely to protect patients from unexpected balance billing by any healthcare provider, service plan or medical facility. 1 This applies to all patients, including self-pay and those covered by individual and group insurance plans. If you want to ensure that your practice is compliant with this new regulation, follow our five tips below.
1 – Educate your front desk and operations staff
When it comes to complex issues, like the No Surprises Act, it is critical to educate and organize your team. The best place to start is with the front desk. Take time to educate your staff on the new billing and legal requirements, then work together to create a new operational plan that follows state and federal government guidelines.
2 – Perform real-time insurance eligibility verification before treatment
Under the new law, healthcare practices must provide documentation that clearly estimates service costs before any out-of-network appointment. This puts the onus on you to accurately ascertain if your services are covered by a patient’s insurance prior to providing treatment. One way to do this more reliably is to implement a tool, like our treatment cost estimator, that performs real-time insurance eligibility checks.
3 – Provide a good faith cost estimate before treatment
The NSA requires practices to provide out-of-network and self-pay patients with an itemized “good faith cost estimate” – that includes specific timeframes – prior to providing treatment. This may seem daunting, but tools like our treatment cost estimator can help. Our platform provides accurate treatment estimates while allowing you to tailor the rules engine and fee schedule to meet your specific needs.
4 – Provide financing options for patients
Although not a requirement of the NSA, helping out-of-network and self-pay patients afford procedures through financing options is a great way to improve your patients’ experiences. In a recent study, 56% of respondents reported that payment plans are “very” or “extremely” desirable, and 73% of bridge millennials agree. 2
5 – Enable online and mobile payments
In today’s digital world, it’s vital to offer patients the chance to pay their bills online. According to US Bank, 44% of patients pay medical bills faster when they receive notifications via digital or mobile methods. 3 If your practice implements payment plans, you should allow patients to pay in whatever way is most convenient to them – be it via mobile device, a computer, a check or in-office. ClearGage’s patient payments platform is an all-in-one solution that allows you to send digital bills and reminders, and then enables patients to pay however they prefer, which in turn helps you receive payments faster.
What happens if you don’t comply with the No Surprises Act?
Entities that don’t follow the guidelines may receive fines and penalties from the state and federal governments. For each violation, you could be subject to fines up to $10,000. 4
If your team doesn’t stay up to date, your practice could also be subject to a drawn-out dispute process. In reality, the only way to avoid a violation is to ensure your billing process is transparent and in full accordance with the law. If you need assistance with treatment estimation, patient financing or an effective payment solution, consider ClearGage’s comprehensive suite of financial technology solutions.
Is your practice compliant?
One of the safest ways to ensure you’re compliant with the NSA is to create a modern, optimized intake and billing process that includes:
- A pre-treatment insurance eligibility verification, and
- A good faith cost estimate that is provided to all patients prior to treatment, but particularly to self-pay and out-of-network patients.
1. Check out our recent blog for an overview of how the No Surprises Act applies to different medical providers.
2. A recent study published by PYMNTS.com “Healthcare Installment Options Proving a Curative for Common Payments Problems” published on September 23, 2021.
3. According to an article by US Bank “Top 3 Ways Digital Payments can Transform the Patient Experience” published on May 26, 2021.
4. According to Kff, “For services covered by the NSA, providers are prohibited from billing patients more than the applicable in-network cost-sharing amount; a penalty of up to $10,000 for each violation can apply.” “No Surprises Act Implementation: What to Expect in 2022” posted on December 10, 2021.