No Surprises Act 2022: What Physicians Still Need to Know

Kathryn BeardFebruary 10, 2022


no surprises act 2022 for physicians

On January 1, 2022, the federal No Surprises Act (NSA) went into effect. At its heart, the NSA aims to empower patients to make more informed financial decisions about their care while eliminating unexpected bills which, prior to NSA protections, have sometimes led to financially crippling outcomes for patients. 

 

For consumers, the NSA has been heralded as a big win that affords much-needed safeguards in a variety of medical situations. The NSA’s out-of-network billing protections apply to those receiving emergency care and non-emergency care from out-of-network providers at in-network facilities,1 and self-pay patients are now entitled to a good faith estimate of expected charges for scheduled services.  


 

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For physicians and health care providers, the NSA comes with its fair share of complexities that impact medical billing practices; pricing transparency is key. To satisfy NSA regulations, physicians and physician groups must identify a patient’s network status before medical bills are issued. They must also inquire whether a patient has or will be using insurance upon scheduling services and provide self-pay patients with appropriate good faith estimates. The NSA also outlines rules for dispute resolutions,2  though healthcare providers should stay alert for changes here as there as several pending lawsuits that challenge current dispute resolution rules.3   

 

A Chance to Create a Better Experience for Your Patients 

Of course, the NSA comes with a golden opportunity that many physicians may not yet realize: the chance to lean into the regulations and go beyond compliance to create a better experience for patients. According to a recent survey, nearly two-thirds of consumers are concerned about their ability to pay for medical expenses.4  Another study found that 50% of Americans have delayed or gone without care due to cost.5   

 

Patients want and need medical pricing transparency. Most have heard horror stories about exorbitant unexpected fees for medical services and that fear can prevent people from seeking the medical help they need. Healthcare providers can serve clients' needs more fully by addressing what services and procedures will cost, removing the fear of the unknown.  

 

As a physician, your focus has always been on delivering exceptional clinical care. Moving forward, helping patients navigate the financial components of health care is likely to become increasingly important to your medical group’s financial well-being. 

 

Top No Surprises Act Resources for Physicians  

For physicians, there’s a lot of ground to cover to understand and comply with NSA rules and regulations. R1’s mission is to support physicians and healthcare providers by providing practical tools and information for navigating changes that impact your practice. Here is a list of resources that will help you navigate the No Surprises Act and prepare for the various ways your practice will be affected: 

 

1. How to Generate Good Faith Estimates

The NSA mandates that uninsured and self-pay patients are entitled to a good faith estimate of expected charges. Upon patient request and when a self-pay individual schedules an item or service, they now must receive a good faith estimate directly from the applicable providers and facilities. Watch on-demand webinar to learn more. 

 

2. How to Lead a Successful Independent Dispute Resolution Process

The payor-provider independent dispute resolution provisions of the NSA apply to payment disputes between noncontracting payors and providers of emergency services or certain nonemergency services provided in a contracting facility. The independent dispute resolution process allows a noncontracting provider or payor to dispute whether the specified rate was appropriate. Watch on-demand webinar to learn more.

 

3. Office-based Physician Resources

Office-based physicians are likely to be more impacted by the good faith estimate requirements of the NSA than the billing and payor dispute resolution processes unless they also provide out-of-network items and services in in-network facilities. To specifically address the needs of physician offices, The R1 Regulatory Group created these reference guides and tools to help office-based physicians navigate the most applicable aspects of the NSA:  

 

 

4. Hospital-based Physician Resources

Most hospital-based physicians will be directly impacted by the NSA’s prohibitions on billing patients for amounts in excess of their applicable in-network cost-sharing, including the balance of a claim that is unpaid by the patient’s out-of-network carrier. Hospital-based physicians who provide scheduled services may also be required to respond to requests for good faith estimates from patients as well as from other providers and facilities. These NSA-related reference guides and tools were created by the R1 Regulatory Group for hospital-based physicians:  

 

 

5. Assessing a Patient’s Network Status 

Understanding a patient’s network status is essential to your ability to comply with NSA regulations. Now more than ever, healthcare providers need to have an efficient process in place to determine whether a patient is in-network. Read article. 

 

6. How to Improve the Patient Experience

The NSA mandates billing transparency in certain situations, but you can improve the patient experience – and, in turn, the financial health of your medical group – by leaning into pricing transparency in other ways. Read article.

 

7. How to Use Technology to Avoid Unwelcome Surprises 

There are several ways technology can help providers navigate the NSA more easily. Learn more about how a technology-backed, streamlined patient experience can ensure compliance Read article. 

 

8. Top FAQs About the No Surprises Act

What is balanced billing? How will the NSA change providers’ billing practices? Does the NSA supersede state law?  R1 Regulatory experts compiled a list of frequently asked questions about the NSA and provided detailed answers. Access FAQs. 

 

How the No Surprise Act May Evolve 

While many physicians are still adjusting to the compliance provisions that went into effect on January 1, more NSA regulations are expected. For example, the law requires insured patients to receive an explanation of benefits (EOB) for scheduled services in advance. While implementation of this mandate has been delayed, it will be going into effect in the future. While no one knows exactly what those rules are going to look like or how they will impact physicians, the R1 Regulatory Group is prepared to move quickly to analyze the requirements and work with our technology and operations partners to ensure a comprehensive response for our customers. 

 

Check Out the R1 No Surpises Act Webinar Series

 

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Author Bio: Kathryn Beard is a Manager of Regulatory Compliance focusing on the physician business for R1 RCM.



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