Update (3/1/2022): The enforcement of the NSA is pending ongoing legislation and potentially adjusted rule provisions. HealthMark continues to remain apprised of changes and will provide ongoing updates.
THE NO SURPRISES ACT - WHAT IS IT?
Surprise medical billing, particularly around a patient receiving care from an out-of-network provider at an in-network facility (i.e. non “shopped” services – think: the anesthesiologist whom you have never met at the facility where you are receiving a knee replacement), has been a long-debated poor outcome in our healthcare environment.
Congress has recently passed the No Surprises Act (NSA), designed to protect patients from unexpected – surprise – medical bills. In an era of increased access to care and efforts to improve coordination among providers, this law was seen as potentially a dramatic step forward towards better transparency within our healthcare system. As with any regulatory change, full implementation takes time, and it takes rulemaking beyond just the act itself. The rulemaking process that followed the passage of the bill has been controversial and the interim final rule proposed in September of 2021 continues to receive scrutiny. Let's break it down:
WHAT YOU NEED TO KNOW NOW
HOW HEALTHMARK CAN HELP
Helping our clients stay compliant is a top priority at HealthMark. If your organization has any questions or needs assistance with how to approach compliance with the NSA, or particularly as it relates to the intersection of one of our products or services, please contact us at firstname.lastname@example.org or reach out to your Client Success Manager.
We are driven to continually provide updates on regulatory shifts and subsequently determine the best ways to partner with our clients as they navigate related changes. Our team is here to help keep your business moving forward and support everything you do to advance and provide excellent patient care.
3. Zack Cooper et al., Out-of-Network Billing and Negotiated Payments for Hospital-Based Physicians, 39 Health Aff. 24 (2020)