Surprise Billing
The goal of the No Surprises Act is to protect patients from receiving bills from out-of-network providers that they did not willingly choose. This means out-of-network providers will be restrained in their ability to balance bill, and will be paid even lower rates by payors. While the law has good intentions, it is skewed in favor of the payors, and the providers are left to scramble. Groups that previously depended on out-of-network billing will have to adapt to this new competitive reality.
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What Does It Mean?
Important Takeaways for your Healthcare Organization
- The Federal law has a key component that makes it different than most of the state laws: The payors are required to engage in a 30- day negotiation period after they initially pay the claim. This is your opportunity to maximize your reimbursements.
- The payors want to avoid the time and cost associated with the dispute process and arbitration.
- Third party pricing companies have a plan to take the pricing and dispute process off the payors hands and save them money.
Upfront Recovery
Wakefield has been helping out-of-network providers negotiate with third party vendors since 2006. The No Surprises Act does not change anything about our Upfront Recovery service except that the potential volume may increase. The payors are planning for an increase in upfront settlement requests, but are not ready to take on the volume of potential disputes from providers, so they have hired third party vendors to take on this task.Wakefield is uniquely positioned to take on all volumes of settlement request from all commercial payors.
Post-Payment-Recovery
Today, Wakefield deploys a service for out-of-network providers to identify underpaid claims and settle them for additional dollars. We take on this task for Aetna, Cigna, and United Healthcare commercial plans. Over time, with the NSA in place, we will look to broaden the commercial plans we can address under this service line.
If you're unsure what your next steps should be, we can help.
Schedule a brief 15-30 minute call with us to discuss your needs and concerns surrounding out-of-network claims and surprise billing. We’re here to help you navigate these changes.
Surprise Billing Webinar
Learn more about what you can do to assist your organization with these changes.
Here are 6 Provisions of the No Surprises Act:
- Emergency services must be treated on an in-network basis
- Cost-sharing cannot be higher than if such services were provided by an in-network doctor
- Non-emergency services must provide patients notice explaining that patient consents to the out-of-network care
- Nearly all private health plans affected
- Access to Independent Dispute Resolution (IDR)
- Payers must pay the “qualifying rate” which is the median in-network in the area.
Get Help With Surprise Billing
Between balancing patients, managing staff, scheduling, evaluating A/R, and more, we know you don’t have time to also keep track of Surprise Billing changes. Let Wakefield take this off your already busy schedule, so you can focus on your patients!
