How Medical Practices Can Leverage the No Surprises Act to Improve the Patient Experience

Updated as of 2/8/22

Surprise medical bills have long plagued healthcare consumers. Consider the patient who has surgery at an in-network hospital only to later find out that their anesthesiologist is out-of-network. Or the patient who sees their primary care physician of 10 years only to later find out the doctor decided a few months ago to participate with all major health plans except their specific plan. The result? An unexpected medical bill.

Then came COVID-19. Patients who previously had insurance became uninsured due to job loss. Patients with insurance switched jobs, and their previously in-network doctors suddenly became out-of-network.

The good news is that the No Surprises Act, which took effect January 1, 2022, aims to change all of this. The goal? To ensure patients aren’t blindsided by surprise medical bills. To accomplish this, medical practices will be required to provide advanced notice of out-of-network coverage for insured patients as well as good-faith estimates for uninsured or self-pay patients.

Cynics may say the No Surprises Act is just another regulatory requirement imposed on today’s already-burdened providers. However, another way to look at it is that the requirement represents an opportunity for practices to improve the patient financial experience, says Joseph L. Rivet, Esq., principal attorney at Rivet Health Law, PLC in Norton Shores, Michigan. It’s about transparency, trust, and rapport. Surprises—especially financial ones—erode that trust, he adds.


Know the requirements


For insured patients, practices must provide notice that they are out-of-network. “This notice and consent preserves your right to balance bill the patient,” says Rivet. “If you don’t comply, you must accept the qualifying payment amount by the payer.”

The rule defines the qualifying payment amount as the median contracted amount for the same or similar item or service in the same geographic region of the same specialty. Although some practices could take a financial hit by accepting this amount, others may see a gain. However, Rivet says it’s nearly impossible to know which will ultimately be the case, making it paramount for providers to issue the notice.

For patients without insurance (and patients who don’t plan to use their health insurance to cover costs), providers must be able to give a  good faith estimate of expected charges before an item or service is scheduled. This includes an itemized list of each item or service as well as the associated healthcare code and expected charge. Practices must explain the good-faith estimate to the patient over the phone or in-person upon patient request and then follow up with a paper or electronic estimate. These estimates must generally be submitted within three days before providing the scheduled services and obtaining the patient’s consent.

[Note: Consumers with health insurance will be able to get these estimates from their health plan.]


How to leverage the rule


Rivet provides these three tips to help medical practices leverage the No Surprises Act and use it as an opportunity to improve the patient financial experience:


1. Create an inventory of all payer contracts.

Does each contract apply to all lines of business or only certain products? Arm front-desk staff with this information so they can provide insured patients with the most accurate information.
 

2. Include the good-faith estimate and notice of out-of-network coverage into the existing pre-registration process.


Ensure registration staff are armed with tools and training that can help them estimate costs.
 

3. Build a case for why out-of-network patients should come to the practice.


Even if a provider is out-of-network, there are plenty of reasons why patients might waive their rights for balance billing protections, says Rivet. For example, perhaps the physician provides exceptional care or offers consumer-friendly options like telehealth, text messaging, or online scheduling. Maybe they’re well-known for a specific treatment or specialty. Leverage these selling points to foster patient relationships, he adds.


Conclusion


The No Surprises Act will undoubtedly prevent consumers from receiving medical bills they don’t anticipate. However, the requirement can also benefit medical practices. More specifically, it can help providers move the needle on the patient financial experience. Practices that view the rule as an opportunity—rather than a threat or burden—can enhance patient satisfaction in the short- and long-term.


We understand this is an on-going process as the government rules continue to evolve. As your trusted partner, look to Kareo to help you along the way. Please check our resources center often for more details as the regulations flesh out. 

 

In the meantime, to find out other ways to streamline your processes and enhance the patient experience in your practice, visit us here. 


 

About the Author

Lisa A. Eramo, BA, MA is a freelance writer specializing in health information management, medical coding, and regulatory topics. She began her healthcare career as a...

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