The No Surprises Act went into effect Jan. 1, meaning out-of-network anesthesia providers are prohibited from balance billing.
Tony Mira, Anesthesia Business Consultants' president and CEO, laid out what providers need to know in a recent blog post.
Balance billing occurs when patients seek a service in a facility covered by their insurance, but an out-of-network practitioner provides the anesthesia. Under the No Surprises Act, the provider cannot bill the patient the difference between the payer and the provider's rate. Now, the provider can expect a reduced rate in line with what Mr. Mira calls the "in-network charge."
Cost-sharing for all emergency services and nonemergency services in facilities that participate with patients' health plans must be determined on an in-network basis. For out-of-network cases, the cost-sharing rate is calculated based on state policies. If the out-of-network provider does not agree with the plan's payment, it may initiate a 30-day payment negotiations period.
When scheduling a medical service, providers must ask about the patient's health insurance status. If the patient is either uninsured or self-pay, then the No Surprises Act's good faith estimates apply. The estimate must include expected charges for items or services, as well as items or services that may be provided by other facilities.
Read more about the changes here.