The No Surprises Act, what is your part?
It has been a while since The No Surprise Act was passed back in December 2020. The face of healthcare certainly has. The law was fully implemented in January 2022, and it was designed to protect patients from most surprise bills. This implementation is across primary target areas and requires transparency of cost before services are rendered. This is especially applicable in areas of emergent care, with a special emphasis on surgical procedures. As part of a move towards greater transparency, providing this information is very beneficial to patients.
The focus of the No Surprises Act
The intended focus for the No Surprises Act was to prevent unexpected bills, especially in the instance of a patient going to the wrong place. Below are the three key areas that are behind the Act.
- Most emergency services, including services received in hospital emergency departments, freestanding emergency departments and urgent care clinics that are licensed to provide emergency services.
- Good-faith estimates (GFEs) for self-pay and uninsured patients
- Non-emergency services at in-network facilities.
What this means for you
What we have seen is the need for more information from providers – more paperwork, frequent updates and demographic verifications. Insurance plans have set up stricter requirements for maintaining practice rosters and location information. Maintaining data files such as Availity and CAQH and other payor portals are more important than ever. Provider portals are the norm for medical offices, billing companies and credential services who maintain and submit applications. Missing or wrong addresses can affect provider payments.
Yes, more hoops to jump through
While moving towards greater transparency is beneficial to all patients, changing systems can mean a lot of work. To help meet these requirements in advance, we ask for more demographic information. We factor this into the quarterly attestation of CAQH, to confirm practice locations are current and up to date.
No surprises
Berkeley Associates has invested significant time, energy, and resources into our CCIM system (our proprietary data maintenance software). These changes and updates allow us to add practice changes for your group in one step, which saves time and avoids spikes in your maintenance costs. ust as the No Surprises act seeks to guard patients against the unexpected, we are working hard to guard you against unexpected surprises as well.
Questions are always welcome! Please let us know if you want to know more about data maintenance for our providers. Berkeley & Associates is working hard to keep you in good standing. We don’t take your trust lightly. Please call our team at 405-849-4016 with any questions. We would love to help.
