More Time and More Automation Needed for No Surprises Act Compliance
As noted here previously, the No Surprises Act -- which is part of the Consolidated Appropriations Act introduced earlier this year -- presents some formidable challenges to the healthcare industry.
The No Surprises Act is so named because it is designed to eliminate some of the surprises that group health plan participants encounter from unexpected charges, which most people will agree is certainly a needed solution. However, as reported at HealthcareDive.com, payers and hospitals are asking for more time to get their "ducks in a row" in preparation to meet the new requirements:
Payers are asking for a safe harbor until 2023 calling the Jan. 1 start day is too soon for plans to determine payment amounts to out-of-network providers and as it seeks clarification on the resolution process.
Safety net hospitals represented by America's Essential Hospitals want implementation to be delayed until six months after the public health emergency for COVID-19 ends, saying staff and resources are spread too thin dealing with the pandemic and especially the spread of the delta variant.
The US Department of Health and Human Services released the first interim final rule to implement the No Surprises Act in June — one of multiple expected to be released this year — including those from the Departments of Treasury and Labor.
Also, the American Hospital Association (AHA) said it is "deeply concerned that the existing oversight mechanisms are insufficient to monitor plan and issuer behavior and a more robust structure is needed to enforce the QPA requirements."
What it boils down to is time. Payer lobby AHIP asked for the good faith safe harbor request to make it possible to develop QPA methodologies, create the infrastructure to transmit notice and consent forms with providers, as well as time for AHIP to receive forthcoming information on the arbitration process.
The group wrote: "Health plans and issuers have responsibility for developing work streams; updating information technology; creating forms, notices, and other communications; training employees; and other operational measures necessary to effectuate obligations" that are set forth in the rule.
One key for payers and healthcare providers alike will be technology. According to Medical Economics:
All this makes it critical for providers to have the operational structures needed to quickly implement and incorporate these rules and regulations into their revenue cycle workflows.
Automation will make this process easier and more reliable. Learning algorithms can consistently determine how to bill patients appropriately using specific rules based on the data being processed. This technology can assess provider type, the location where services were provided, network provisions, etc., and determine the appropriate billing process. Having the ability to hardwire compliant processes in a provider’s revenue cycle is critical because it minimizes the risk of billing errors and ensures claims have all the information needed to be processed successfully.
The deadline is quickly approaching and, in the current health climate, it is understandable that resources are stretched thin. However, we have noted that healthcare innovations have seen a boost during the pandemic; and, in order for providers and payers to achieve compliance with the new regulations, they need to partner with vendors with technologies like AI. Both payers and providers should not stop at just meeting the regulations, but also evaluate how these technologies can help achieve other goals like data interoperability -- where all the data created can be utilized by multiple systems. Players in the healthcare industry need to understand that you are not alone, and reaching out to your technology vendors is the right course of action to ensure that you are indeed in compliance.
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