Client Testimonial: Werking Medical Billing
Werking Medical Billing aka WMB, is a medical billing service provider that offers quality, cost...
“Surprise billing" may be an unfamiliar term, but chances are you or someone you know has experienced it. If you've been "surprise billed", you have received an unexpected bill from a facility or healthcare provider. This usually happens because you've received medical care from a provider or facility outside your health insurance plan's network. When that occurs, the insurance company isn't paying, so you get the bill -- definitely an unpleasant surprise. Keep reading part three of our "New Year, New Rules'' #rtblogseries to learn more!
No Surprises Act
Under the No Surprises Act, out-of-network services are treated as if they were in-network when assessing patient cost-sharing. As a result, the No Surprises Act sets up protections that apply to most consumers who don't receive their health coverage through federal programs, including the uninsured and those who self-pay.
The Exceptions
There are exceptions to who is eligible under the No Surprises Act. Specifically, the Act does not include people with coverage under the programs, which already have protections against high medical programs, including:
The rules of the No Surprises Act apply to you if your healthcare coverage is through your employer, including local government, state and federal employers, along with those who self-pay or are uninsured. Also, if you're insured through a multi-employer plan and/or are covered through the federal or state-based marketplace, then the protections of the No Surprises Act apply to you.
The Complications Of Medical Billing
To help everyone start adapting to new rules, the No Surprises Act rolled out in increments. The rollout began on July 1, 2021, with part one of the interim final rule, which established restrictions on surprise billing in employer-based and individual health plans. Under this provision, patients receive in-network billing rates for emergency or non-emergency services from out-of-network providers working at in-network facilities, including air ambulance services.
A second interim final rule opened for public comment on September 30, 2021. This added more protections against surprise medical billing, including:
Lastly, on November 17, 2021, a third interim final rule set requirements for group health plans and issuers to cover prescription drugs and healthcare spending. Included are requirements governing information on the most expensive and most frequently dispensed drugs, along with information on enrollment, premiums as well as average monthly costs employees pay compared to employers.
Summary Of Changes Occurring In 2022
The No Surprises Act is a complicated piece of legislation, so to summarize it, here are the key points set to begin January 1, 2022:
What does this mean for patients? Healthcare consumers can expect the following:
The more you know, the better prepared you are to adapt to the No Surprises Act. While the Act should help alleviate some financial burdens for healthcare consumers, it can create new administrative hurdles for providers. Healthcare organizations must ensure they end balance billing and be prepared to provide upfront estimates as well as good faith billing to patients.
Having robust revenue cycle management (RCM) technology in place can help you navigate changes and consistently provide excellent patient experiences. You can rely on our all-in-one digital healthcare platform to manage the complexity of your RCM processes while also ensuring full compliance with the No Surprises Act. Get in touch with us to learn how we can help you grow your Therapy and Rehab practice!
As a retired nurse and teacher, I now spend my time writing freelance as well as working on my debut novel. Please like, comment and share. Thank you!
Werking Medical Billing aka WMB, is a medical billing service provider that offers quality, cost...
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