Billing in healthcare went through some massive changes since the beginning of the pandemic. While
most of those changes were to deal with the immediate chaos in the medical ecosystem, the federal
government and the Centers for Medicare and Medicaid Services have now come out with rules that will
stabilize the medical industry’s financial situation and offer the patients the best possible
outcome. While some regulations like the No Surprises Act will already come into effect from the
beginning of 2022, some laws like the price transparency rule have seen unavoidable delays.
Medical billing professionals should be thorough about these new rules as they will change how the
regular workflow goes on in a traditional provider organization. While revenue leaders discuss the
pros and cons of the new regulations, providers must gear up for the standard measures that they
need to follow in the coming year. Here are some of the few changes that will affect billing in
healthcare in 2022.
Price Transparency Rule
With an aim to make healthcare costs more transparent for the patients to decide about their
treatment plan, the price transparency rule is a step forward in improving the healthcare ecosystem.
Though the law is set to bring positive changes to the provider organizations and the patients, not
all parts of the rule will be effective from the following year. Here is what healthcare industry
leaders have to say.
Changing the healthcare delivery mechanism into a consumer-friendly care delivery ecosystem is one
of the most revolutionary steps of the price transparency rule.
However, the healthcare leaders believe that the most valuable outcome of the rule can only be
achieved when all the clauses of the Act come into effect.
Due to the long list of compliance measures and the pressurizing situation due to the pandemic, some
of the adherence clauses have shifted their deadlines to 2023.
The price disclosure requirements on behalf of the healthcare systems will allow the patients to
browse the different treatment plans and their costs.
According to the leaders, this will give the patients an “Amazon-like experience” wherein they can
compare their costs and their desired outcomes.
This particular part of the price transparency rule allowing an individual to avail of these
services has unfortunately been delayed till July 1, 2023. However, the leaders are optimistic that
they will soon come into play.
The management has cited delay in compliance adherence as the major reason for the delay in
implementation of the rule. The providers have put in a word with the regulators that they need a
deadline extension to follow the rules.
Some medical billing professionals also thought that initially, there was some lack of clarity in
the language of the rules. The clarified guidelines also suffered some delay, due to which the
implementation got pushed back further.
This suggests that in 2022, the providers and the healthcare organizations will be taking steps to
scale up their existing systems to implement the rules within time.
No Surprises Act
The No Surprises Act comes as another step to strengthen the patient’s ground in the case of their
treatment, especially in case of an urgent matter or an emergency. The No Surprises Act comes into
effect from January 2022, with the initial rules phased out sequentially.
The No Surprises Act puts an end to the balance billing method in healthcare, thus ensuring that
patients are not billed enormous amounts due to emergency treatment at an out-of-network provider.
This rule goes beyond helping patients better understand the healthcare ecosystem and their probable
health plans. It will also foster better working terms between the provider organizations and the
health plan providers.
The health plan providers and the healthcare systems need to reach a consensus regarding the
reimbursement for the emergency out-of-network treatment that the patient needs to undergo.
This marks a step forward for value-based care, too, since both the plan providers and health
systems need to agree to the appropriate qualifying rates for the emergency care rendered to the
patients.
Even in case of any conflicting issues regarding the consensus between the two parties, the matter
will be settled by the federally appointed mediator.
This means a great win from the patient’s side. In any situation, their interests will be the first
priority, and they can focus on their recovery rather than the complex rules of the billing
methodologies.
Some of the essential clauses of this Act will come into effect from January 2023. However, 2022
marks when all provider organizations will prepare for the changes and deploy crucial tools for
smooth implementation.
Pointers for Teams under Billing in Healthcare
The in-house billing teams must know what changes are coming into the medical industry and how they
will affect their daily workflow.
The teams need proper guidance on the new methodologies of billing in healthcare so that they can
implement the new rules without any friction.
Staff training programs on how to implement these changes would help the transition be smoother
without any unnecessary obstacles.
Some of the clauses of these new rules also depend on how the health systems and their billing teams
communicate with the patients.
The CMS has published a set of guidelines on how to implement the No Surprises Act. These documents
contain important pointers like a good faith estimate calculator and dispute resolution mechanisms.
They also have guidance papers on how to communicate with the patients to get complete information
during the onboarding process.
If your in-house team under billing in healthcare is struggling to implement the new changes in
2022, you can get in touch with a leading RCM company to help you with the process.
We hope this article helped you know what changes are going to take place in the American medical
industry in 2022. For any queries, connect with us in the comment section below. Please subscribe to
our blog for more such articles on healthcare technology and management. Follow us on
LinkedIn, Twitter,
Instagram, and
Facebook.