How one can stay compliant – and hold sufferers completely happy – amid implementation of the No Surprises Act


Medical bills

Patients put their trust in hospitals and doctors to care for them, and that trust should also extend to how their provider is billing them for their care. That can only happen when the patient is privy to how they are being charged. There are a plethora of items and services that can run up a patient’s bill, but only 14% of hospitals are entirely compliant with price transparency rules, according to a recent report. This can pose a problem, as the No Surprises Act mandates transparency and only requires patients be liable for in-network costs. However, more than a year after the law went into effect, a significant number of hospitals have continued to not be forthright about what they’re charging.

Finding a solution

Unsurprisingly, one of the top concerns of patients is their final cost of care. They want predictability, and rightfully so, as the cost of care can have a major impact on financial stability. With the cost of care marked by national inflation, it’s imperative that providers address financial expectations early on. By providing consumers with a Good Faith Estimate (GFE) – a branch of the No Surprises Act – patients are provided a more accurate and transparent estimate and are, in turn, better protected from making ill-informed financial decisions. This will bolster a provider’s patient base, because when consumers are aware of the costs, they are more likely to reasonably afford the care.

As it stands, many health providers calculate estimates using systems and technology that simply do not keep pace with regulatory changes. Complex payment cycles confuse patients and their providers, often resulting in missed or reduced payments, as well as inefficiency. This is when the issues begin to also negatively impact the financial stability of health care providers, warranting revenue cycle transformation. It is essential for providers to address costs as early as possible in the patient collection workflow. Through end-to-end RCM transformation that utilizes AI and machine learning tools in tandem with a patient statement delivery and online portal that streamlines patient collections from pre-visit scheduling to post-visit follow up, transparency and compliance is strengthened, creating a healthcare environment that is favorable for providers, patients, and payers.

Understanding costs before care is received

An estimated 23 million patients have collected medical debt – including 11 million who owe more than $2,000. Care plans are increasingly becoming a costly household expense. In general, before people make a major purchase, they often compare prices and are aware of estimated costs. Receiving medical care should be no different, particularly as healthcare consumerism accelerates. Insurance eligibility and payment estimation tools enable providers to specify at the time of scheduling what the liable out-of-pocket costs will be. By providing patients with an estimate prior to care, all parties are better prepared and aware if there is any necessary assistance that will be needed, including payment plans.

There is always a possibility of situations arising during treatment that could permit extra charges, but that’s simply not something a health care provider can always predict. Regardless, giving patients the best knowledge pertaining to expected costs ahead of time is the best course of action, as it will increase point-of-service (POS) reimbursements and help to lower the bad debt associated with write-offs for patient balances. Providers who use cost-estimate solutions will minimize claim denials by gathering medical eligibility verification, deductible information and co-pay costs while strategizing how best to address the financial aspects of a visit prior to the patient being seen. To achieve and maintain compliance, while providing patients with the most accurate cost estimates possible, providers are empowered to identify patterns in patient healthcare spending with the help of secure, digital patient statement delivery – allowing them to provide patients the flexibility they need.

After care is received

Complex payment cycles can be confusing to patients and providers, but revenue cycle transformation can help to reduce the number of missed payments, as well as keep employers in compliance with the No Surprises Act. The utilization of an online portal that’s secure and convenient can simplify the processes and communication after a patient is seen. Because more than half of insured patients will pay more than $500 each year out of pocket for medical costs, workflows should be tailored to also focus on higher POS reimbursement rates. By offering patients the simplicity and flexibility to pay through multiple channels, providers are better engaged in encouraging patient reimbursements following care. The elimination of surprise costs promotes mutual engagement, streamlining the process for both office administrators and patients.

A revenue cycle management operation that utilizes the right automation and patient collections solutions helps providers to better pinpoint what a patient will have to pay for their care, creating the transparency that is required to remain compliant with the No Surprises Act. It also improves essential processes and increases revenue, all while closely monitoring risks, prices, quality and the influence of reimbursements. Providing a secure and successful revenue cycle management operation that enables administrative staff to estimate patient responsibility and accept payments at any time will create a solid foundation for optimal patient-provider relations.

Photo: fizkes, Getty Images



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