Posted by:  Adam Turteltaub

The No Surprises Act is a patient-friendly piece of legislation designed to protect consumers from unexpected medical bills.  As Sandra Joe (LinkedIn), Senior Compliance Analyst at NorthShore University HealthSystem explains in this podcast, surprise bills had typically arisen in three cases:

* A patient visits an out of network provider in an emergency

* While at an in-network facility, charges are incurred by an out-of-network provider

* When self-pay patients undergo a procedure and only find out what it costs after the fact

The No Surprises Act established new Federal protections to prevent these costly occurrences.  It bans out of network cost-sharing and balance billing.  It also requires that health care providers and facilities provide easy-to-read and understandable notices explaining their billing protections and providing information on who to contact for patients who are concerned that their protections were violated.

For the uninsured and those choosing to pay for their own procedures, the law provides that they receive a good faith estimate, at least one day in advance, for a scheduled procedure.  If the charges exceed the estimate by $400 or more, patients have the right to dispute the cost.

So what should compliance teams do?  Be sure to document the steps you take to put proper controls in place, including the training that is provided to the workforce.  Familiarize employees with how to update good faith estimates if there are changes, and make sure the necessary disclosures are posted in both provider settings and on the website.

Listen in to the podcast to learn more about how not to be surprised by the requirements of the No Surprises Act.