Rising medical debt is now shocking 140 billion U.S. dollars, Is the largest source of debt for American households. A large part of this is the direct result of unexpected billing. one third Of insured adults said they had received unexpected bills in the previous two years.Well, not surprisingly Two-thirds of American adults I am worried about whether I can afford these unexpected medical expenses. This is a problem that concerns so many patients that the state and federal governments are now paying attention to it and taking action. To help solve this problem, Congress signed the No Accident Act and made it into law.
this No accident, Effective January 1YingshiIn 2022, it aims to protect consumers from at least one problem: accidental billing for out-of-network care in emergency and non-emergency situations.About One in five emergency claims and one in six online hospitalizations Include out-of-network bills, usually due to emergency or ancillary care. Since patients lack meaningful choices when choosing these unexpected services, they have no choice but to pay or face negative reviews on their credit reports. Usually, although the health plan covers part of the bill, the patient still needs to pay the remaining balance.
On-demand webinar: “Unlocking the No Accident Act”
In this 60-minute meeting, Roger Johnson, Vice President of Payer Solutions at Experian Health, and Stanley Nachimson, Health IT Implementation Specialist, helped providers quickly understand what they need to do to comply with the No Accident Law. This on-demand webinar will help your organization understand the new regulatory requirements and provide strategic advice on how to prepare.
Watch now
By enhancing price transparency and consumer protection, the new regulations will help create a better patient experience and ensure that fewer bills are written off as bad debts. However, according to a recent survey conducted by Experian Health, only 72% of providers are familiar with the No Accident Law. That’s not all-only 40% of respondents have a moderate degree of confidence that their organization can solve the “No Accident Law” problem. Payers and suppliers must take immediate action to ensure that their processes are ready to adapt to these changes.
Solve the problem of price transparency through the “No Accident Law”
Healthcare pricing has always attracted attention, there are several New regulatory measures Introduced in recent years. The new bill was signed into law under the Comprehensive Appropriations Act of 2021. It builds on previous federal actions and empowers patients by giving them more access to medical cost information.
January 2022, Out-of-network emergency services, off-network air ambulance services, and off-network non-emergency services provided by in-network facilities will no longer allow balance billing. Regardless of whether the provider is in the health plan’s network, the insurance company must cover emergency services without any prior authorization, and the patient should pay the same fees as the services in the network. The bill requires providers and health plans to help patients obtain health care pricing information, and providers must provide consumers with tools to obtain better price estimates, including “good faith estimates” that cover all relevant codes and costs.
The bill stipulates the process of reimbursement of medical plans to providers and arbitration in the event of a disagreement.
Summary of provisions in the “No Accident Law”:
- Protect patients from unexpected medical bills due to gaps in coverage between emergency services and certain services provided by off-network facilities
- Require patients to be only responsible for the amount of cost sharing within their network, and require that without the patient’s consent, the patient’s cost sharing shall not exceed the cost of the network
- Provide guidance for providers and insurance companies on how to negotiate fair reimbursement for out-of-network services
- This includes requiring providers to submit good-faith estimates to payers and using these estimates to create and provide members with pre-stated benefits.
- However, the implementation of this requirement has been postponed until more guidance related to these file transfer standards can be provided (as of October 2021)
What preparations does the supplier need to do now?
Creating a “no surprises” billing experience will require major process changes by payers and providers. Roger Johnson, Vice President of Payer Solutions at Experian Health, said: “The new regulations require the industry to make major innovations in a short period of time. Determining the state of the network is a huge challenge for providers, just like getting patients electronically The same is true before the service. There will also be challenges in tracking and submitting consent forms, generating good faith estimates, applying appropriate cost sharing, billing, payment reconciliation and new dispute resolution procedures.”
See what Roger said in our expert interview:
Experian Health is working with industry partners to clarify regulations and working with customers to adjust workflows to achieve a smooth transition.learn more Our on-demand webinar.
At the same time, various Price transparency tool The purpose of existence is to help providers meet ongoing regulatory requirements and create a better patient experience through easy-to-understand cost breakdowns. E.g:
- Patient Payment Estimate Before the point of service or before the point of service, provide patients with a clear and accurate estimate of authorized services, enabling them to better control their financial obligations. The tool has a user-friendly interface that helps patients plan and pay bills, while guiding them to choose the appropriate financial assistance options. And because it is automated, hospital staff will no longer need to manually update the price list.
- For providers, this tool can use out-of-network benefits to create on-demand integrity estimates.
- Patient Financial Advisor It is a text-to-mobile service that allows patients to check estimated care costs before coming to the hospital. The solution provides a complete breakdown of the program, as well as a total estimate based on the benefits within the network.
- Register the accelerator Document imaging system capable of collecting provider forms and returning them to customers.
- Claim source Risky claims can be identified before they are submitted to the payer.
- Claim scrubber Risky claims can be identified from multiple perspectives, such as:
- Non-network payer
- Non-participating suppliers
- Services provided without approval
- Services provided outside of approved authorization standards
Although regulatory changes may seem daunting, price transparency has moved in the right direction.Our second Patient visit status survey It shows that both patients and providers want to increase price transparency. Nine out of ten suppliers told us that they agree that price transparency can improve the customer experience and increase the likelihood of paying patient bills.Regulations may be a catalyst for change, but Make it easier for patients to understand and pay bills Continue to pick up momentum. This is good news for the patient’s wallet and the provider’s bottom line.
Download our on-demand Internet Conference, “Open the No Accident Act” to learn more about how the new regulations will affect the workflow of patients and providers.
Learn about Experian Health’s price transparency tool
Post No surprises bill summary: what your organization needs to know First appeared in Healthcare blog.
