How the No Surprise Act Affects Healthcare Providers (and How to Stay Compliant)

Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers that they did not choose. Studies find this happens in about 1 in 5 emergency room visits.

In addition, between 9 and 16 percent of in-network hospitalizations for non-emergency care include surprise bills from out-of-network providers (such as anesthesiologists) whom the patient did not choose.

Surprise medical bills pose financial burdens on consumers when health plans deny out-of-network claims or apply higher out-of-network cost sharing; consumers also face “balance billing” from out-of-network providers that have not contracted to accept discounted payment rates from the health plan.

Effective January 2022, the No Surprises Act (NSA) established new federal protections against surprise medical bills. It prohibits doctors, hospitals, and other covered providers from billing patients more than the in-network cost sharing amount for surprise medical bills.

The federal government estimates the NSA will apply to about 10 million out-of-network surprise medical bills a year. They are taking this seriously, allowing civil penalties of up to $10,000 for first-time violations.

The NSA will protect consumers from surprise medical bills by:

• requiring private health plans to cover these out-of-network claims and apply in-network cost sharing. The law applies to both job-based and non-group plans, including grandfathered plans.
• prohibiting doctors, hospitals, and other covered providers from billing patients more than the in-network cost sharing amount for surprise medical bills.

What Does the No Surprises Act Mean for Healthcare Providers and Insurers?

Healthcare providers must provide information about the No Surprise Act, cost related to services, consent forms, educational and informational materials, and any other communication pertaining to cost of out-of-network providers to patients in plain language or the patient’s preferred language.

This applies to a wide range of caregivers, including hospitals and other healthcare facilities, emergency room physicians, out-of-network providers, ambulance companies, health-insurance issuers that offer group or individual health insurance coverage, and federal health benefits program carriers.

Each must show good faith estimates related to care costs – and they must do so in plain language or the patient’s preferred language.

What Opportunities Does This Present?

While this will be an adjustment for healthcare providers, the No Surprises Act also presents opportunities.

The NSA allows health providers to create a pricing structure for all their items, services, and providers that follow the same protocol across the board, regardless of whether or not the individual has health insurance or is paying for their care out-of-pocket.

It will also help health providers create easier workflows for their own billing staff and reduce phone calls from patients trying to understand afterward why they are paying for certain items, services, or providers.

Another important consideration is inclusivity, as providers will be sharing content that all their patients can understand, regardless of language or cultural background. This demonstrates a high level of compassion and commitment to their community. This is a high-touch opportunity for healthcare providers to show that they truly care about their clients and patients.

What Steps Should Organizations Take? 

There are several steps that healthcare providers should take immediately.

• Educate employees. All relevant employees must understand the No Surprises Act and how it impacts their workflow and the people they serve.
• Work collaboratively. Create a work team that incorporates employees and suppliers to analyze the cost and pricing of services, items, and providers. The output should be an easy-to-understand price list or table.
• Analyze and update current materials. Check all current documents and forms to ensure they are up to date. Identify languages spoken most often in the region and prepare communications in advance. This is a great opportunity to ensure that content is easy-to-read and the language is accessible.
• Partner with a language service provider. Ensure accuracy for the materials you have created in the languages your patients and clients need.

LanguageLine^(R) Can Help

Partnering with LanguageLine Solutions is enormously advantageous for organizations attempting to maintain compliance with the No Surprises Act.

LanguageLine works with 18 of the top 22 healthcare systems in the U.S.

LanguageLine’s Translation and Localization^SM division provides translations of forms, documents, email communications, apps, live chats, websites, and educational materials in over 290 languages. For quick-turnaround projects, we offer Machine Translation with human post-editing (MTPE). We have proofreading and quality assurance workflows in place for all of our projects, including higher-liability content like medical documents.

LanguageLine Clarity‌^SM helps simplify the written word so that anyone can understand the message you are trying to convey. By using our Microsimplification process, you can save money on translation projects over time.