On January 1, 2022, the No Surprises Act became law. In our recent webinar, “[Part 2] No Surprises Act: Employee Impact & Broker Fee Disclosure,” Mployer Advisor CEO & Founder Brian Freeman was once again joined by James Bristol and Stacy Hooper of Waller, a Nashville-based law firm.
Together, our speakers explained the impact of “surprise” balance billing, examined best practices to ensure compliance, and reacted to evolving realities surrounding the new protections. Here are a few takeaways from their insightful conversation.
1. What Is Balance Billing?
Balance billing occurs when a provider bills the patient for the difference between a provider’s charge and the insurance carrier’s allowed reimbursable amount. It typically happens when a provider bills out-of-network fees and the carrier refuses to pay them, causing the patient to be put in the middle. The “surprise” occurs when patients are notified—after their care is provided—that their care was out-of-network, which results in higher and unexpected charges.
2. Fast Facts About Balance Billing
· Balance bills cost employees ~$20B a year.
· Over 1:5 ER visits will result in a surprise medical bill.
· Surprise bills are the single-largest driver of bankruptcy in the U.S.
Balance billing occurs in different ways for both emergency and non-emergency services. These can include services such as air ambulance, ER visits, or ancillary services like radiologist, anesthesiologist, and pathologist performances. This could also apply to specialty services like responding to unexpected complications performed by a neonatologist or cardiologist.
3. How Will Surprise Medical Bills Be Solved Moving Forward?
To resolve this issue, there will now be what’s called an independent dispute resolution, or IDR. This includes a resolution process where if either the provider or the plan disagrees about the bill amount, they will then send it on to a third-party arbitrator. These rules are intended to give providers and plans an opportunity to come to an agreement about a particular claim.
4. Regarding Broker Fee Disclosures, How Is Compensation Defined in the No Surprises Act?
If you receive more than $1,000 a year in compensation, you have to disclose. This includes direct and indirect compensation. As a service provider, brokers are required to submit these disclosure requirements for each of your clients.