The No Surprises Act protects patients from surprise medical bills, like the one received by the patient in this picture.

The No Surprises Act: Protections for Insured & Uninsured Patients

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EligibilityAdvocates Blog

The No Surprises Act:

Protections for Insured & Uninsured Patients

Posted on Monday, November 15, 2021

The bipartisan No Surprises Act will go into effect on January 1, 2022.

The No Surprises Act is intended to protect patients from surprise medical bills (when patients are unknowingly treated by out-of-network providers) and balance billing (when patients are charged for the remainder of what their insurance does not pay).1

Read on for an overview of the new rules and how this law affects both insured and uninsured patients.

Overview of the No Surprises Act


“Requirements Related to Surprise Billing; Part I,” an interim final rule issued July 1, 2021:
  • “Bans surprise billing for emergency services” which “must be treated on an in-network basis without requirements for prior authorization.”1
  • Restricts surprise billing for “non-emergency care from out-of-network providers at in-network facilities,”2 which protects patients who are not given the chance to choose an in-network provider.
  • Restricts surprise billing for “air ambulance services from out-of-network providers.”2
  • Extends protections from balance billing, which is already prohibited by Medicare and Medicaid, to “Americans insured through employer-sponsored and commercial health plans.”1
“Requirements Related to Surprise Billing; Part II,” an interim final rule issued September 30, 2021:
  • “Details a process that will take patients out of the middle of payment disputes.”3
  • Provides “a transparent process to settle out-of-network (OON) rates between providers and payers.”3
  • Outlines “requirements for health care cost estimates for uninsured (or self-pay) individuals.”3

How Does the No Surprises Act Protect Uninsured Patients?


The No Surprises Act protects patients from surprise medical bills, like the one received by the patient in this picture.

The No Surprises Act protects patients from surprise medical bills.

This law requires that providers or facilities inquire about patients’ insurance status when scheduling and “provide a good faith estimate of expected charges for items and services” to uninsured/self-pay patients (those who do not have benefits for an item/service under a health plan or who choose not to have a claim submitted to their plan for the item/service).4

CMS Administrator Chiquita Brooks-LaSure explained, “we are requiring health care providers and health care facilities to provide uninsured patients with clear, understandable estimates of the charges they can expect for their scheduled health care services.”3

If an uninsured or self-pay patient is billed for an amount “substantially in excess” ($400 or more) of the good faith estimate they received, they may be eligible for the “patient-provider dispute resolution process” to determine a payment amount. This process must be initiated within 120 days of receipt of the bill.4


In addition to instituting financial safeguards, the No Surprises Act can also improve healthcare access. As HHS Secretary Xavier Becerra stated, “No patient should forgo care for fear of surprise billing.”1 With these new rules in place, patients may be less likely to postpone or avoid needed healthcare due to concerns about the financial ruin that often comes from surprise medical bills.

Lowering Patients’ Healthcare Costs


The new protections established by the No Surprises Act can help lower both insured and uninsured patients’ out-of-pocket healthcare costs by sheltering them from unexpected and/or excessive medical bills.

EligibilityAdvocates can further reduce patients’ medical expenses by helping them obtain health coverage and/or financial assistance. Our Patient Advocates work one-on-one with patients to determine their eligibility for various insurance plans and benefit programs and assist them with the application process.

Additionally, we can help patients resolve their patient balances and understand their patient responsibility.

Contact us to learn more about how the No Surprises Act will affect patients or to get in touch with a Patient Advocate.

Sources

1 CMS (U.S. Centers for Medicare & Medicaid Services). “HHS Announces Rule to Protect Consumers from Surprise Medical Bills.” (2021). Retrieved from https://www.cms.gov/newsroom/press-releases/hhs-announces-rule-protect-consumers-surprise-medical-bills

2 CMS (U.S. Centers for Medicare & Medicaid Services). “Overview of rules & fact sheets.” (2021). Retrieved from https://www.cms.gov/nosurprises/Policies-and-Resources/Overview-of-rules-fact-sheets

3 HHS (U.S. Department of Health & Human Services). “Biden-Harris Administration Advances Key Protections Against Surprise Medical Bills, Giving Peace of Mind to Millions of Consumers Plagued by High Costs.” (2021). Retrieved from https://www.hhs.gov/about/news/2021/09/30/biden-harris-administration-advances-key-protections-against-surprise-medical-bills.html

4 CMS (U.S. Centers for Medicare & Medicaid Services). “Requirements Related to Surprise Billing; Part II Interim Final Rule with Comment Period.” (2021). Retrieved from https://www.cms.gov/newsroom/fact-sheets/requirements-related-surprise-billing-part-ii-interim-final-rule-comment-period


By Stephanie Salmich

A Patient Advocate assists a patient, and the blog title appears – The Keys to Increasing Patient Collections: Patient Communication & Financial Education

The Keys to Increasing Patient Collections: Patient Communication & Financial Education

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EligibilityAdvocates Blog

The Keys to Increasing Patient Collections:

Patient Communication & Financial Education

Posted on Monday, April 12, 2021

A successful strategy for increasing patient collections must be proactive.

Unfortunately, many patient collection efforts are hindered by reactive methods (e.g., lack of price transparency or out-of-pocket estimates, hard-to-decipher medical bills) that result in uncertainty, stress, and confusion for patients.

When patients are confused about what they owe and why they owe it, they often delay making payments or do not pay their bill at all. Additionally, those with high or unexpected medical bills are more likely to call the hospital’s billing office with questions or complaints. And if they feel they’ve had a poor experience with the billing department, they are less likely to pay their bill in full or in a timely manner.

A Proactive Plan for Increasing Patient Collections

A proactive approach involves two key elements: patient communication and financial education. EligibilityAdvocates employs both in the services we offer.

Patient Communication


EligibilityAdvocates’ on-site patient eligibility service increases self-pay conversions and improves patient collections through better patient engagement. Our Patient Advocates meet with patients one-on-one and in-person to assess and help them understand financial assistance opportunities and their options, all while they are still at your facility and before they are billed.

Equipped with mobile screening technology, our Patient Advocates are also able to meet with patients at home, in the field, or at bedside. We also offer Emergency Department staffing and expanded hours compared to most patient eligibility and enrollment services. We have on-site Patient Advocates available at a minimum of 12 hours/day, 6 days/week, helping to ensure your patients find support when they need it.

Furthermore, we want to improve the patient experience with consistent communication which includes follow up with email, SMS text, and phone calls. Rather than waiting for (potentially upset) patients to call you, we reach out to them before they receive a complex bill that leads to anger, frustration, or bad debt for your organization.

Financial Education


Our Patient Advocates provide financial education to patients by counseling them on the financial aspects of their healthcare and their options for funding it. This includes informing them of government and/or charitable programs for which they may qualify, aiding them in the application process for health coverage and/or financial assistance, and helping them understand their health benefits and patient responsibility.

In addition, our Patient Advocates assist patients with resolving their patient accounts (for example, by collecting their ER co-pay and/or any prior balances, or by setting up a patient payment plan). Our pre-arrival workflow solution can also estimate patients’ out-of-pocket costs in order to prepare them for their financial responsibility.

A Patient Advocate assists a patient, and the blog title appears – The Keys to Increasing Patient Collections: Patient Communication & Financial Education

A proactive approach to increasing patient collections involves two key elements: patient communication and financial education.


Increasing Patient Collections with EligibilityAdvocates


EligibilityAdvocates’ services can eliminate patients’ out-of-pocket costs or leave them with a reduced and more manageable portion of their bill to pay. Plus, patients who understand their health benefits and financial options, medical bills, and patient responsibility are much more likely to make their payments.

Proactive patient communication and financial education will lead to greater and faster reimbursement from patients – and improve patient loyalty as well!

An on-site patient eligibility service gives your patients the opportunity to meet face-to-face with an experienced Patient Advocate who can provide personalized education and empower your patients to navigate the financial complexities of their healthcare. And all our services are free to the patient as we are contracted at a performance-based rate with each healthcare facility.

Contact us today to learn more about our proactive approach to increasing patient collections.


By Stephanie Salmich