On December 27, 2020, the United States Congress adopted the No Surprises Act (NSA) as part of the Consolidated Appropriations Act of 2021, which has various provisions to assist in protecting customers against unexpected costs beginning January 1, 2022. The following course highlights the NSA and how it impacts healthcare.
What you will learn:
- Situations where the No Surprises Act applies
- Specific requirements for compliance with the No Surprises Act
- Billing and payment processes under the No Surprises Act
- The importance of accurate documentation
Details
Course length: 45 minutes. CME: 0.75
Languages: American English
Key features: Audio narration, learning activity, and post-assessment.
American Medical Compliance is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing education to physicians. Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve healthcare outcomes. Through high-quality educational activities, we aim to address the identified educational gaps to support the continuous professional development of our medical community. American Medical Compliance designates this activity for a maximum of 0.75 AMA PRA Category 1 Credits. Physicians should only claim this credit for their complete participation in this activity.
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Requirements of the No Surprises Act (NSA)
The provisions in the NSA establish requirements such as cost-sharing standards, limitations on balance billing for specific services, notice and consent requirements, and disclosure requirements for balance billing protections. Additionally, the NSA applies to health care practitioners, facilities, and providers of air ambulance services.
In general, these standards apply to commodities and services given to individuals participating in group health plans or group or individual health insurance coverage, including Federal Employee Health Benefit programs. Individuals without health insurance are subject to the NSA’s obligations for the patient-provider dispute resolution process. Some health insurance coverage systems, such as Medicare and Medicaid, are exempt from the NSA since they already have protections against unexpected medical billing.
Balance and Surprise Billing
When a health care provider bills a patient after the patient’s health insurance company has paid its portion of the bill, this is known as balance billing. After the patient has paid any copays, coinsurance, or deductibles, the balance bill is for the difference between the provider’s charge and the price set by the insurance company.
Surprise billing occurs when a patient receives an unexpected balance bill after receiving care from an out-of-network clinician or facility. Patients are frequently unaware that a provider or facility is out-of-network until they get a bill. In addition, it can occur in both emergency and non-emergency situations. To learn more and bring this information into your healthcare facility, click the button below.
