What you need to know about the No Surprises Act

Wednesday, December 8, 2021

A new issue brief could help revenue integrity leaders educate their departments and organizations on the main points of the No Surprises Act and how it will affect their organizations, HealthLeaders reported.

The brief, published by the Office of the Assistant Secretary for Planning and Evaluation Office of Health Policy, is divided into sections that provide background about why the rule, which goes into effect January 1, 2022, is needed. It also covers state-level approaches and key provisions of the rule.

For instance, it cites data showing that “on average, 18% of emergency room visits by people with large employer coverage result in one or more out-of-network bills and nearly 20% of patients undergoing in-network elective surgeries or giving birth in a hospital received surprise bills. Surprise bills in these studies averaged more than $1,200 for anesthesia, $2,600 for surgical assistants, and $750 for childbirth.”

It also outlines the No Surprises Act's implementation, how it will impact consumers, and the process for resolving disputed claims.

Finally, the issue brief notes that there are some elements of The No Surprises Act that will remain unknown until the rules are actually implemented and evaluated, including:

  • How often the independent dispute resolution (IDR) process will be used
  • Whether IDR process usage will vary based on the size of the insurer or on other characteristics
  • Whether the 30-business-day pre-IDR negotiation period will lead to disputes being resolved sooner
  • Whether batching of similar claims will happen, and if so, what its impact might be

It concludes that the No Surprises Act’s reporting requirements “will provide the evidence needed to evaluate the law's performance over time to inform any future policy changes that may be warranted in this area.”

The issue brief doesn't wade into the ongoing protests by hospitals and physician organizations, such as the American Medical Association, which calls the proposed arbitration rules “an undeserved gift to the insurance industry.”

Nor does it address the concerns of 152 lawmakers who signed a letter arguing that the rules “do not reflect the way the law was written, do not reflect a policy that could have passed Congress, and do not create a balanced process to settle payment disputes.”

In related news, CMS announced on November 19 that it's forming the Ground Ambulance and Patient Billing Advisory Committee, which was mandated by the No Surprises act.

Congress left ground ambulances out of the No Surprises Act off pending further study, and this new committee will eventually provide recommendations about how to protect consumers against “exorbitant charges and balance billing when using ground ambulance services.”

Implementing the provisions of the No Surprises Act will be complex, and organizations still face many questions as the January 1, 2022, effective date approaches. NAHRI Advisory Board members Ronald Hirsch, MD, FACP, CHCQM, and Caroline Znaniec, MBA, MS-HCA, discussed the ins and outs of implementing the act on the November 16 NAHRI Quarterly Call. Znaniec and Hirsch shared case studies and tips to help revenue integrity professionals navigate the intricacies of the act and avoid potential pitfalls.

Editor’s note: Find more NAHRI resources on the No Surprises Act here.

Found in Categories: 
Compliance, Revenue Integrity