Each year, millions of Americans are affected by surprise medical bills ranging from hundreds of dollars to hundreds of thousands of dollars. This so-called “surprise billing” can be devastating to patients and their families, but the good news is this unfair practice is coming to an end.
What Is Surprise Billing?
Surprise bills -- also known as balance billing – can be unexpected out-of-network care in an emergency, as well as scheduled procedures at an in-network facility. Patients expect these bills to be covered by insurance, but a disagreement between healthcare providers and health care plans on how much is owed leaves patients and their families caught in the middle.
And this isn’t a rare phenomenon. Studies estimate one out of every six hospital visits result in a surprise medical bill.
The No Surprises Act
This legislation was signed into law in December of 2020 and goes into effect for plan or policy years beginning on or after January 1, 2022, giving health care providers and insurers time to prepare for its implementation.
The No Surprises Act will end the following types of surprise bills, so patients will only be responsible for their usual cost-sharing amounts and deductibles. The Act covers:
- No surprise billing for emergency care, whether the patient is taken to an ER out-of-network OR seen by a medical provider not covered by their insurance.
- No surprise billing for scheduled care, providers must give 72-hours notice of the estimated charges and provide the patient the opportunity to approve or decline the care.
- No surprise air ambulance bills, patients will only be required to pay the in-network cost-sharing amount for any situations that require urgent medical transport.
This act provides a fair process for healthcare providers and insurers to settle payment disputes without putting financial distress on the patient. Unless they are notified prior to receiving care and agree to the additional charges, patients will only be responsible for their in-network cost-sharing payments.
What Does This Mean for Healthcare Providers?
The No Surprises Act is not intended to harm healthcare providers acting in good faith. It’s primarily intended to reduce the reimbursement rates among the small segment of providers who have used balance billing (surprise billing) strategies to charge exorbitant rates for their services at the expense of their patients.
It also increases transparency in the healthcare system, as insurers will be required to be up to date with provider directory information, deductibles, and limitations, and fair-service costs.
Read some of the No Surprises Act FAQs here!
About Medical Business Management
Medical Business Management (MBM) is a full-service claims, billing, and medical practice management company. We specialize in generating cash flow and maximizing revenue for our clients, and we have extensive experience with anesthesia medical billing. We take pride in the accuracy, efficiency, and results of our service.
To learn more about how we can help your healthcare facility maximize revenue from medical services and claims, contact us here!
