Revenue leaders across the USA are taking measures to keep their revenue cycle up and running after the federal government passed the No Surprises Act earlier in July 2021. While the Act’s clauses need careful evaluation, revenue cycle directors are trying their best to improvise their current medical billing systems to make the most out of the new legislation. Financial protection of the patients is a top priority, which leads up to the passage of this bill. But how is it going to affect the current revenue cycle management practices? Healthcare organizations must take strict note of a few crucial changes that can help them to maximize their reimbursements.

In this article, we will talk about the primary points of the No Surprises Act, how they are going to affect the cash flow of providers and how organizations should improve their workflow for the better to change the scenario positively.

What is the No Surprises Act?

The No Surprises Act is a part of the Consolidated Appropriations Act COVID-19 relief bill. The Act is aimed to protect the patients from surged and unexpected healthcare bills. These ‘surprise’ bills mainly occur when patients have to seek urgent medical services from out-of-network providers.

Here are some points that the act highlights:

  • Any emergency medical service will be considered an ‘in-network’ service and will be billed in the same manner. This will ensure that the patients do not receive massive bills post-treatment from the out-of-network care provider, which is the basic ground of passing this act.
  • The out-of-network co-payment or deductible bills cannot be higher than the cost incurred if the provider was in-network with the patient’s insurance. This clause is aimed to decrease the burden on the patient’s account significantly.
  • The act also eliminates any out-of-network bills for ancillary providers like radiologists or neonatologists. The reason is that the patients primarily do not select any of the ancillary providers on their own. They are assigned to them by the facility.
  • The facility should present the patients with the estimated medical cost in advance. Any such out-of-network charges that have been put on the bill without any advance notice have to be eliminated.

How to improve Medical Billing Systems with this Act?

Healthcare organizations should take significant measures to improve their billing methodologies to keep their cash flow upwards without compromising on the act regulations. Revenue leaders should take proactive steps to keep up with the changing revenue management policies.

Harvey Rochman from Manatt, Phelps & Phillips, LLP said, “Revenue cycle leaders need to be highly focused on NSA implementation, which will have major impacts on hospital operations and will require many new processes and strategies to be implemented in the next six months.”

Here are some of the strategic areas that you should look into:

Patient Onboarding Process:

  • The aim of the revenue cycle still remains to be a clean claim. In the light of the recent No Surprises Act, filing a clean claim can reduce the time taken for reimbursements from payers.
  • It is seen that 40% of the denied claims occur due to wrong or missing patient details. So the first step should definitely be to make the patient onboarding process an error-free one.
  • It is best to have a digital management system in place so that the details of the patient can be recorded without the risk of manual errors. Insurance details are crucial when negotiating the bills with the payer.
  • According to one of the clauses of the Act, the organization should communicate about the financial responsibility of the patient well in advance. Swift and correct eligibility verification become crucial for this to work.

No Balance-Billing:

  • The act puts an end to simple balance billing, taking a step forward towards revised revenue management policies.
  • The billing team is supposed to go through the reimbursement amount and check whether it is acceptable to the facility and provider.
  • The negotiation period of 30 days is provided by the Act between the payers and the providers. The billing team should use it to the best of their knowledge to maximize the benefits. Otherwise, it will pass on to the independent dispute resolution (IDR) process.
  • This means that organizations must have skilled teams to work their way around this with new and improved medical billing systems. It is best to start staff training programs early on.
  • In case you are understaffed, outsourcing medical billing companies can help you with superior teams of expert professionals.

Consent Waivers:

  • The No Surprises Act mandates the option of consent waivers to be given to patients once the medical emergency is over and the patients switch to non-emergency care.
  • Once the urgency of the medical situation has died down, the patients can choose to be relocated to a facility that is in their insurance networks.
  • If the patient chooses to stay in the same out-of-network facility, then they have to sign a consent waiver stating the same.
  • This is also applicable in cases where patients choose to continue with a particular out-of-network provider in an organization where in-network providers are present.
  • If the patient signs such an agreement in line with the consent waivers, then the clauses of the NSA will not be applicable to their account anymore. The billing team can proceed with their traditional methods and prepare a balance bill for the patient.
  • Health organizations should be ready to incorporate these resources in their workflow management.

Update Provider Details:

  • Since the Act primarily focuses on out-of-network billing, healthcare organizations must ramp up their existing logs to update the provider details.
  • Any mismanagement in the paperwork during the patient onboarding process can cost the organization dearly.
  • With the price transparency rule, you must be prepared to give a correct estimate of the medical bill beforehand. Updating the status of a provider in your directory will help you to navigate the amounts better.
  • The patient eligibility verification process should be simpler so that the plan details can be accessed by the patient and the billing staff on time.
  • Software tools can be highly beneficial for this job. You need not spend time verifying each and every service through the plan details manually.
  • This step is vital to ensure that the cost-sharing rates with respect to the payer’s plan are on point, leading to maximized revenue for your facility.

Experts recommend that the medical facilities should start improving their existing medical billing systems without any further delay to stay compliant with the clauses of the Act. Optimizing the revenue cycle management with the help of automation technology and medical billing experts can go a long way to benefit the cash flow.

We hope this article helped you understand how you can strategize your medical billing systems to make the most out of the No Surprises Act. For more such articles on healthcare management and technology, please subscribe to our blog. In case of any queries, you can comment below, and we will get back to you soon. Follow us on Twitter, LinkedIn, and Facebook to get regular updates.