No Surprises Act Compliance: Easier Said Than Done

No Surprises Act Compliance

We’re four months into the No Surprises Act, which is best known for its payment transparency for patients. However, putting these regulations into practice  – particularly providing good-faith estimates – is already a nightmare, states a number of compliance experts. 

It’s well known that the healthcare industry is full of complex regulations, and Surprise Billing just makes things more “daunting” for healthcare providers, states experts. 

Praised for tackling one of the primary issues for patients – being stuck with unexpected, usually high medical bills because they may have been unknowingly cared for by a medical professional that was out-of-network – the other side of the coin will leave medical professionals and compliance professionals hustling to remain in compliance with this new legislation. 

Harvey Rochman, a Manatt professional services firm partner, has compared the No Surprises Act to a “small Affordable Care Act (ACA)” because there are a variety of lesser-known requirements of the bill that might come as a shock or will be extremely difficult to put in place. 

Rochman continues, “If you had to single out one thing that is really the most complex and difficult…it’s the good-faith estimate.” According to the bill, a broad range of providers will be required to provide these estimates to its patients. For example, dermatologists, who don’t provide emergency services at hospitals, will be subject to provide good-faith estimates. 

Additionally, providers will be under strict time constraints to provide these good-faith estimates to patients. In some cases, it might be one day after the procedure is scheduled. In other situations, providers will have three days to provide the estimate within 10 days of scheduling the procedure. 

There’s also the issue of determining who the “convening provider” will be to provide the estimate – is it the hospital or the specific surgeon? The AHA drafted a letter to the CMS stating that putting these measures in place have been difficult for even the most seasoned and sophisticated hospitals; it’s extremely difficult to automate, and many estimates need to be tailored to each patient. 

As we’re in the early stages of the No Surprises Act, compliance will continue to be an uphill battle for providers and hospitals, and will be very costly to those that are unable to achieve compliance. This is a developing story that AdvantEdge will be keeping a close eye on. 

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