The No Surprises Act took effect on January 1, 2022, and establishes federal protections against surprise medical bills. While the legislation serves a legitimate patient protection purpose, it has many providers puzzled and technologically unprepared to comply.
During Becker's Hospital Review's 7th Annual Health IT + Digital Health + RCM Annual Meeting, in a session sponsored by PFS Group — an accounts receivable management firm based in Houston — Miguel Vigo, chief revenue officer at University of California San Diego Health, and Mark Evard, vice president of revenue cycle at Hospital Sisters Health System, led a discussion about how providers are attempting to solve a problem with many unknowns.
Three key takeaways were:
- Organizations are facing numerous challenges related to the No Surprises Act. Roundtable participants shared some of the obstacles they have encountered: their EHR vendors have not built essential dashboards and functionality, getting front-end staff up to speed is a challenge and there is a lack of clarity about which department must inform patients about service charges when that information is hardly knowable before examining the patient.
"You're asking registration staff to make medical assumptions," one attendee said. "You're asking arguably some of the lowest-paid folks to know all of the compliance terms and documents to sign, ask the right questions, populate all that data [like] financial experts and have a smile all at the same time," another participant said. "Trying to get your staff to give an estimate that's worth something is very difficult," a different participant acknowledged.
- To address those challenges, providers are engaging in patient education campaigns. Some campaigns have taken the form of providers going out to community centers and senior nursing facilities and doing "mindshare communication" to help patients there sign up to MyChart. MyChart has enabled automatic popups that inform patients upon making a healthcare appointment that they will receive an estimate for the service they are seeking, which is one of the Act's requirements. "We listen to our patients to tell us where [the signup process] is most cumbersome," one participant said.
- MyChart's popups are an example of provider-EHR vendor partnerships attempting to ease compliance with the Act. Some healthcare providers are teaming up with EHR vendors to help generate price estimates for health services, as required by the Act. One roundtable participant said their organization had a positive experience with a vendor that yielded accurate surgery-related estimates, but the organization continued to face difficulties with information related to balanced billing.
Another participant noted that while such tools can be helpful to a degree, the complexities of continuous price changes, new services being added and inclusion of co-providers mean that hospitals and health systems eventually outgrow the tools' usefulness.
Still another participant suggested that relying on such tools is challenging because generating an accurate charge estimate cannot realistically be achieved prior to the patient visit. "We have no earthly idea what the physicians are doing and they have no earthly idea what they're doing until they actually get the patient scheduled and see them."