Surprise medical bills”. This issue has become a hot topic for the last few years. Stories and news of patients left with thousands of dollars of medical costs are quite upsetting for both patients & healthcare providers. Surprise billing occurs when a patient receives medical care from healthcare facilities, outside of their payer’s network. As a result, healthcare providers bill the patient for the amount their insurance payers didn’t cover.

Patients have complained that: the majority of the laboratory practitioners do nothing to alert patients about the out-of-network healthcare services before the final bill is presented. According to a recent survey, approximately 43% of patients’ visits to the emergency department and 42 percent of all hospital admissions resulted in out-of-network charges. And caused surprises for the patients with unexpected medical bills, averaged $628 and $2,040, respectively.

In some cases, it has been estimated that some medical bills were extremely shocking. For instance, a patient was charged $50,000 for just an allergy test and in another case a $500,000 for dialysis. Unfortunately, the majority of the surveyed patients revealed that: most of the time they have no idea that they had received the medical care services that were not in their payers’ network.

When patients aren’t really prepared for the medical bills, that they don’t expect. It will become difficult for many of them to pay their out-of-pocket bills easily. That ultimately results in a pile of unpaid/underpaid copays and coinsurances. Healthcare experts believe that collecting complete payments from patients is an extremely challenging task for lab practitioners. And failure to collect patients’ copays in a timely manner ultimately negatively impacts the revenue cycle and financial viability of healthcare practice.

However, the US government has realized the worsening situation related to the surprise medical bills and come up with a solution too. The recently implemented ‘No Surprise Act’ will play an active part in protecting patients from “excessive” out of pocket costs and obviously, surprise medical bills.

The rule banning surprise billing will go into effect on January 1, 2022. The basic purpose of the introduction and implementation of the No Surprise Act is to improve the payment systems across the healthcare industry. By curbing the burdensome out-of-network bills of the patients. In this way, patients can get emergency medical aid without the fear of large amounts of bills. Which usually occurred due to the out of network care services. This act is likely to work as a key indicator that will relieve the financial burden of both patients and healthcare providers.

As a laboratory practitioner, have you made strategies to keep your lab billing services up with this newly implemented act? If not, then you must know the fact that failure to keep your lab billing and payment in accordance with this federal law will not only deprive you of reimbursements. But you can also face legal troubles in some cases. Regardless of whether you are running an associated or independent lab practice. As a revenue leader, it is crucial to analyse the Acts’ clauses carefully. And take necessary measures to make their current laboratory billing systems compatible with the act. That is also important to ensure the ever-flowing revenue stream.

No doubt, the financial protection of the patients is the utmost priority of both government & healthcare providers as well. But have you thought about how the No Surprise Act will affect your reimbursements and revenue cycle management as a whole? If not, then it’s the right time to plan crucial changes that can help them to take full advantage of this act.

If you are in continuous search to know the impact of the NSA and how to upgrade your billing systems accordingly, read this article carefully. This article contains a comprehensive view of the No Surprises Act, its effect on the lab medical billing services and how can healthcare practice keep pace with this changing landscape of payment collections.

What is the No Surprises Act?

This act is a part of the Consolidated Appropriations Act COVID-19 relief bill. As we have already discussed, the NSA aims to protect patients from unexpected and large amounts of medical bills and enable them to receive emergency healthcare services without any fear.

Key provisions of this act are as following:

  • Bans surprise billing for emergency services. Emergency services, regardless of where they are provided, must be treated on an in-network basis without requirements for prior authorization.
  • Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates.
  • Bans out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances.
  • Bans other out-of-network charges without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.

Tips to Improve Lab Billing Systems With this Act?

Laboratory practitioners around the United States should take significant measures to devise the most effective billing and coding strategies. That helps them to keep their revenue cycle profitable and compliant without compromising on the act regulations. Moreover, laboratory administrators should be highly focused on NSA implementation. Which is going to impact their practice operations drastically and will also require many new strategies to be implemented in the coming five months.

Here are the following strategic areas that need attention:

1. Patient Onboarding Process:

Enhanced patients’ satisfaction always remains a priority of laboratory practitioners. However, according to one of the clauses of the Act. It is the first and foremost responsibility of the healthcare organization to effectively communicate its financial policies in advance. It is the right of the patients to get to know about the copays, they have to pay from their pockets, before receiving the medical care services.

So, lab technicians can make a huge difference and stay compliant with this act, by improving the process of patient onboarding. You should change the strategies that can improve the process of welcoming new patients, getting them registered, and make them aware of how things work at your laboratory practices. For this purpose, you should train your front end staff to deal with the patients efficiently. Make sure that your staff convey to the patients about their financial responsibilities and due payments.

Improving the onboarding process will not only help you to stay compliant with the NSA. But it also enhances the efficiency of the entire laboratory billing services. When your registration staff will become more knowledgeable about their responsibilities. Then they will ultimately collect the patients’ demographic and basic insurance information with more attention and accuracy.

As we all know, approximately 40% of claim denials occur due to invalid patients’ details. But when you make the patient onboarding process an error-free one, it ultimately leads to a high rate of clean claims. As a result, healthcare providers get maximum reimbursements back in their accounts.

The best solution to keep your front desk operations optimized is to have a digital management system in place. Using technology-driven solutions i.e. the EHR system ensures that patients’ records are being kept without the risk of manual errors. It also simplifies the process of prior authorization and the verification of the patients’ insurance eligibility.

2. Put An End to Balance Billing:

While taking a step forward towards improved revenue cycle management policies. The No Surprise Act has put an end to balance billing. That occurs when a healthcare provider charges the patients for more than the normal deductible and coinsurance out-of-pocket costs.

Hence, lab practitioners should make sure that their billing teams go through the reimbursement amount. And check whether it is acceptable to the healthcare facility and provider. This act will give a negotiation period of 30 days, in which healthcare providers can negotiate the payments with the payers if they are not satisfied with the received amount. In case of failure to come to a conclusion within this time period, it will pass on to the independent dispute resolution (IDR) process.

Due to the growing complexities in medical billing and coding services. Healthcare providers should never rely on employees having zero to little knowledge about managing RCM tasks. Now with the implementation of this new act. Hiring a team of experts and highly trained billers and coders have become the need of the hour. Because keeping the billing and coding systems as per the federal laws requires unique expertise and experience as well.

In case, you are lagging behind your revenue goals and can’t afford the high expenses of hiring an in-house billing team. And giving them the required facilities to execute the billing and coding tasks efficiently. Then outsourcing lab medical billing services is the best option for the financial success of your healthcare practice.

Outsourced professional companies can help you with superior teams of expert professionals. So, you can get the services of industry experts at fixed and affordable costs.

3. Consent Waivers:

The No Surprise Act gives the option of consent waivers to the patients when the medical emergency is over and they shift back to the no-emergency care. After the end of emergency care. Patients can have the option to get back to their healthcare facility that is in their insurance networks.

However, if they decide to continue with the network healthcare organization, then they are bound to sign a consent waiver stating the same. In case, when patients sign such an agreement in line with the consent waivers. This particular clause of the NSA will not be applicable to such patients anymore. In such a scenario, your billing teams can stay stuck to the traditional methods and prepare a balance bill for the patient.

Are you feeling frustrated while upgrading your billing systems in accordance with the new act? Don’ worry. Let Laboratory Billings be the part of your administrative teams and forget about the compliance issues. It’s an industry-leading lab billing company that has been serving the US healthcare industry for a considerable amount of time. Our experts always stay at the top of the changes in the medical industry and provide RCM solutions accordingly. Contact us today and get ready to embrace the innovations.