Surprises can be great for birthdays, but they’re awful when it comes to healthcare. Unexpected bills, where a patient is charged more than what they were prepared to pay, are a leading cause of medical debt for consumers. And yet they are terribly common—every year, the USA sees an estimated 10 million surprise medical bills, and even one in six in-network hospitalization comes with a surprise bill.
But recent legislation aims to change this. The No Surprises Act (NSA) is designed to protect consumers from unexpected medical bills. It does so through two main provisions: healthcare providers must bill out-of-network patients the same as they do in-network patients, and private health plans must cover out-of-network claims with the same cost-sharing amounts they use for in-network care.
For your medical practice to comply with the NSA, it’s important to develop a strategy for providing patients with a reasonable estimation of their financial responsibility ahead of rendering your services. This can be difficult, as there are many variables at play, but there are tools to help.
Here’s what you need to know about the No Surprises Act, and what your practice can do to easily comply with the new regulations.
Complying With the No Surprises Act
The No Surprises Act was introduced as part of the Consolidated Appropriations Act of 2021. This was a broad effort to protect consumers from surprise billing through insurance coverage. The legislation prohibits balance billing in certain out-of-network emergency services, as well as certain other services provided by out-of-network health care providers. The act also requires insurers to cover services provided by out-of-network practitioners in an in-network facility—an out-of-network anesthesiologist working at an in-network hospital, for example.
The provision most likely to affect your practice, however, is the requirement to provide a good-faith estimate of what a patient will be billed for your services. The easiest way to do that is to use a Patient Responsibility Estimator tool.
By calculating out-of-pocket costs such as deductibles, copays, and co-insurance amounts quickly and accurately, these tools can show exactly what the patient will owe before they receive their bill. This eliminates any surprises after they visit the doctor or hospital.
Choose a Patient Responsibility Estimator that can be integrated right into your practice management software to create a seamless workflow. This will give your office managers access to real-time information about what payments are due without having to check multiple databases manually.
A Patient Responsibility Estimator will make it easy to comply with the new law. It will also help your practice to get paid faster and in full. By giving patients up-front information about what their out-of-pocket expenses will be, your practice can avoid the delays caused by unexpected charges that a patient isn’t prepared to pay. Patients are also more likely to be prepared to pay at the time of service, which helps shorten your billing cycle.
Improving your pricing transparency helps to provide a better overall patient experience, which is essential for retaining patient loyalty and building your reputation as a provider. So not only will you be in compliance with the new legal requirements, but you’ll be also providing better service to your patients.
And if all that isn’t enough, just remember that every violation of the NSA carries a fine of up to $10,000.
Estimating Costs with CollaborateMD
To help you comply with the No Surprises Act, CollaborateMD has launched a new Patient Responsibility Estimator. It’s built in to your existing CMD workflow, making it easy to determine patient responsibility, get paid faster, and provide patients with valuable price transparency.
This is an important new feature of CollaborateMD, adding extra value to our current suite of practice management solutions. Our new Patient Cost Estimator fits right in with automated patient statements, our online payment portal, and integrated payment processing to give your practice a comprehensive solution for estimating and collecting payments and making it easy to run your practice more efficiently.
Schedule a demo with one of our experts to find out more about patient estimates and improving patient experience.