Congress passed the No Surprises Act in December to protect patients from surprise billing. Below are four ways hospital and payer executives can prepare for the legislation, which takes effect next year, according to professional services firm PwC.
1. Review billing systems. Providers should conduct a review of their data systems and insurance verification systems. The accuracy of cost estimates to patients and insurance verification will be essential when the legislation takes effect, according to PwC.
2. Work on consent waiver communication. The legislation allows certain out-of-network providers to seek written consent from patients that will allow them to balance bill. Providers should get a clear communication strategy in place and identify the patients who may fall into the category that may be interested in paying out-of-pocket for these procedures. Providers should also ensure they have a process and documentation system in place to ensure they have proof of both the written notice and consent.
3. Implement an arbitration strategy, balance-billing mitigation strategy. Payers should work to understand the scenarios in which out-of-network care occurs and expand out-of-network mitigation strategies to prevent surprise bills. Payers and providers should also put a strategy in place to know when to pursue arbitration.
4. Build trust with consumers. Payers and providers should focus education efforts on providing clarity about the legislation and pricing information to build trust and strengthen the patient-hospital or member-payer relationship.
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