The “No Surprises Act” and Pediatric Patient Billing

Have you heard about the No Surprises Act? This groundbreaking piece of federal legislation was passed in 2021 and took effect on January 1st, 2022. At its heart, the aim of the act is to protect patients from unexpected medical bills that could adversely impact their finances and prevent them from seeking or receiving much-needed medical care.

Recently, Julia Kuna, Office Practicum’s Implementation Project Manager, told us more about the No Surprises Act on the PediaTricks podcast, and shared how this new legislation could impact OP clients and their practices.

What is the No Surprises Act?

The No Surprises Act creates protections against unanticipated medical bills. These unexpected medical bills are an unfortunate reality of the pediatrics landscape – they happen when a patient is inadvertently given care from a provider or facility that is out of their insurance network.

This is not as uncommon as you might think – surveys have found that as many as 1 in every 5 emergency visits involve unexpected medical bills. Even an emergency visit that is in-network may have certain components that may catch the patient unawares – as is the case in up to 16% of in-network emergency room visits.

There are several parts to this legislation, and not all are in effect at the moment. So, expect that there will be more changes as the act is finalized.

Why is the No Surprises Act So Important?

When providers can help patients understand their liability, it makes it easier for them to receive the care they need. Everyone’s financial situation is different, but what’s universal is that receiving a good-faith cost estimate up-front makes it much easier for the patient to understand their situation and budget for it accordingly.  

To facilitate this for all patients, practices must have an up-to-date self-pay fee schedule to help patients who are uninsured or opt for self-pay understand their costs for the care being provided. In OP, providers can assign each patient a specific fee schedule, so everything links up and is right there to view and show to the patient. 

Another critical ruling within the No Surprises Act is one that removes patients from the disputes that are ultimately between the provider and the insurance company. This should help resolve conflicts between a patient, their providers, and the insurance company by ensuring that healthcare providers can only collect an in-network rate, even if they are providing care to a patient at an out-of-network facility. 

How OP Can Help Practices Comply with the No Surprises Act

In addition to making it easier for providers to assign each patient a specific fee schedule, OP can offer a few other tips to help your practice get ready for the changes that the No Surprises Act may bring.

• Check that your office contact is up to date with payers and that regular provider registry reminders are received. You may also find it helpful to designate at least two contacts to safeguard that your office will never be locked out of your account for any reason.
• Practices should familiarize themselves with their state guidelines. Since this is a federal law, there may be a chance your existing state guidelines are less stringent, in which case the practice would be obligated to change some current policies to comply with the No Surprises Act. 

Want to learn more about the impact the No Surprises Act can have on your practice? Check out the “Financial Security and the No Surprises Act” podcast to hear our whole discussion.