The No Surprises Act limits unexpected charges on medical bills. Passed in 2020 and funded in 2021, it protects insured and uninsured consumers from unanticipated fees. While not all-encompassing, it’s a step forward in the financial transparency process that makes healthcare more affordable.
What Exactly Is the No Surprises Act?
The No Surprises Act is a consumer advocacy law with several key provisions, including:
Balance Billing Protections
The No Surprises Act prohibits healthcare facilities from billing patients for excess fees if an out-of-network provider unknowingly or unavoidably treats them for an emergency or in-patient stay. Patients are responsible for paying only in-network fees unless they agree to out-of-network services. Providers are further required to disclose out-of-pocket costs.
Provider Directories
Finding an in-network provider is no longer a guessing game. Insurance companies must maintain up-to-date lists of in-network providers, usually on their websites, for quick and easy access. And under most plans, consumers are eligible for continuing care at in-network rates for up to 90 days after a provider opts to leave the network.
Good Faith Estimates
At their request, healthcare providers must give uninsured patients a good faith estimate for services. Consumers can dispute bills that exceed the projection by more than $400.
Mediation Provisions
Healthcare facilities are free to negotiate reduced rates on out-of-network fees for which they can’t bill patients. If they can’t agree, an independent mediator will ensure the fair distribution of costs.
Air Ambulance Fees
Air ambulances are rare but costly and once led to large balance bills for many insured. However, patients are only responsible for in-network costs, regardless of the distance traveled, for emergency care. The No Surprises Act does not cover the convenient use of air ambulances for non-emergencies.
How Does the No Surprises Act Affect the Work of Medical Assistants and Medical Billing and Coding Specialists?
The No Surprises Act doesn’t change what medical assistants do, but it does impact how they do their work. As healthcare professionals, they must be more responsive to patient inquiries and adjust their approaches to care in these critical ways:
Patient Education
As patients’ first point of contact, medical assistants play a crucial role in explaining the implications of the No Surprises Act to patients and their families, helping them understand their rights and responsibilities regarding billing and insurance coverage.
Network Verification
Medical billing specialists may be asked to verify which providers are in-network for insured patients, helping facilities provide transparent estimates. Medical assistants may need to confirm the network status of specialists before referrals are made.
Informed Consent
Medical assistants may be involved in obtaining patient consent for out-of-network services. A notice of rights and an estimate of charges must be provided to patients at least three hours before an appointment. Patients must offer each in a language the patient understands, often necessitating interpretation services.
Suppose a patient isn’t allowed to consent to treatment by an out-of-network provider. In that case, facilities are limited to billing for in-network costs, reducing their revenue.
Coding Accuracy
The No Surprises Act emphasizes transparency and dispute resolution so that coding errors could lead to billing disputes. Accuracy is critical.
Dispute Resolution
Medical billing and coding specialists may collaborate with administrators on solutions in a billing dispute. Medical assistants may be asked to clarify medical documentation to assist with coding audits, giving their employers the best possible advantage.
Continuing Education
Like most significant rules, provisions in the No Surprises Act are still being interpreted today. Court decisions continue to flow in. Medical assistants must stay abreast of new requirements that clarify existing statutes, committing to continuing education as part of their career development.
What Other Regulatory Guidelines Must Medical Assistants and Billing Specialists Follow?
Federal, state, and local governments create rules to protect the public against potentially misleading billing practices. But that’s nothing new for medical assistants and medical billing and coding specialists who already adhere to these well-established regulatory guidelines and more:
HIPAA
The Health Insurance Portability and Accountability Act (HIPAA) was enacted to protect workers from losing their health coverage when changing or losing jobs. But it also governs how medical assistants, billing, and coding specialists can use, share, and store sensitive health information.
Medical Necessity
More of a guideline than a rule, medical necessity provisions impact which services insurers cover. Medical assistants help support the necessity of healthcare services through thoughtful documentation. Medical billing and coding specialists convey medical necessity through accurate coding on insurance forms. Services may not be upcoded solely to increase reimbursement.
Emergency Medical Treatment and Labor Act
The Emergency Medical Treatment and Labor Act (EMTALA) requires medical centers to stabilize patients needing emergency care regardless of their ability to pay. The act affects the payment collection processes medical assistants and billing specialists typically use.
The HITECH Act
The Health Information Technology for Economic and Clinical Health (HITECH) Act promotes adopting data technology, such as electronic medical records. An extension of HIPPA, it also mandates compliance audits.
Medical assistants protect their employers from liability by following the rules. Facilities face hefty fines for even minor violations.
Medical Debt Collection
Patients are responsible for paying if a medical bill is lawful and accurate. However, all debt collection is subject to regulation, with medical debt collection laws being even more stringent in some states.
Facilities, for example, may not make harassing phone calls or, in some areas, deny patients even non-emergency care if they have an overdue balance. Billing representatives must notify patients of third-party collection efforts, including their right to dispute the amount owed.
Final Thoughts
The No Surprises Act is one of many new laws passed to protect public health. But it’s among the first to target financial transparency and billing practices specifically. Allied health professionals, including medical assistants, are vital to its implementation and success.
Meridian College offers a hands-on Medical Assistant training program taught by experienced school faculty who know how to prepare you for the daily challenges you’ll face on the job. From assisting doctors with patients to critical administrative tasks, our experienced teachers will train you for a rewarding new career.
Contact Meridian College today to learn more about becoming a medical assistant.