Understanding The No Surprises Act: Using An Infographic

It sometimes feels like there’s a new healthcare-related law coming out every day. The No Suprises Act  (NSA) is the latest one—and we’re here to go over everything your practice must know about it. 

The No Suprises Act is a federal law that went into effect in 2022. The law is intended to protect health insurance consumers from surprise medical bills. These are the unexpected, out-of-pocket costs for healthcare services rendered by out-of-network providers.  

While this is clearly a beneficial protection for patients, what does it mean for providers? In this article and infographic, we’ll help you navigate the new rules put in place by the NSA. 

Protecting Patients Against Millions of Surprise Medical Bills Each Year 

It’s estimated that 10 million surprise medical bills happen each year. In fact, about 1 in 5 emergency room trips and 1 in 6 in-network hospitalizations leave patients with surprise out-of-network bills.  

Unexpected high-cost bills can have a disastrous impact on a patient’s financial well-being.  

The NSA seeks to protect patients from these surprise costs through two main requirements: 

• Healthcare providers cannot bill out-of-network patients more than they do in-network patients for the care provided. 
• Private health plans will need to cover out-of-network claims using the same cost-sharing amounts as they do for in-network care. 

Here’s a quick infographic to help you understand the NSA at a glance: 

Simply put, these new protections mean that insured individuals likely will not have to pay more for out-of-network care than they would for in-network care.  

The NSA applies to emergency services and other common sources of surprise bills, including when a patient sees an out-of-network provider at an in-network facility. 

How Patients & Practices Benefit from the NSA 

Obviously, the No Surprises Act will benefit patients with protection from surprise out-of-network costs. But the advantages don’t stop there—and they extend to providers too. 

Empower Patients 

With the No Surprises Act, healthcare consumers are empowered to make smarter decisions around their medical care. This is thanks to the greater insight they’ll have into potential out-of-pocket expenses and changes in coverage terms that come as a surprise.  

Strengthen Insurer-Provider Relationships 

The NSA also encourages insurers and providers to work together and be more transparent with one another, as well as with the patient, which could help reduce costs all around. Increased transparency will help build greater trust between insurance companies and medical providers. 

Improve the Patient Experience 

This new need for pricing transparency is also a great win for the patient experience. With the No Surprises Act in play, providers have a responsibility to give patients an accurate estimate for the cost of services, creating an open dialogue around what the patient can anticipate.  

A patient who gets the bill they expect is more likely to have a good experience, which in turn helps promote loyalty to your practice. 

The Value of a Built-In Patient Cost Estimator 

A patient cost estimator is an important tool for ensuring your practice complies with the requirements of the No Surprises Act.  

It provides patients with an estimate of their out-of-pocket costs before receiving a service, so they’re aware of what to expect and can make an informed decision about their care.  

Cost estimation also helps protect you against potential liabilities caused by violations of the NSA, as all parties involved have agreed on the estimated costs prior to any treatments being provided. 

Streamline the Estimation, Billing & Payment Processes 

Having a cost estimator built into your EHR/PM software will make providing required estimates to patients as easy as clicking a button. Then, you and your patients can have more accurate financial conversations upfront to ensure everyone knows what to expect and reduce frustration for both parties. 

Using a patient cost estimator also improves the billing and payment experience by allowing your practice to explain different payment plans and options to your patients ahead of time. Having this knowledge makes it easier for them to find coverage or funds that may fit within their budget.  

Plus, when patients aren’t caught off guard by pricing changes, payments are more likely to be collected on schedule. 

Simplify Patient Cost Estimates at Your Practice 

Overall, using a patient cost estimator promotes greater transparency between healthcare providers and patients while helping ensure compliance with the No Surprises Act.  

It gives both sides more control in understanding what they can expect financially upfront. This helps facilitate better communication, improved customer service experiences, and reduced liability risks for healthcare providers. 

If you’re ready to see how the iSalus Patient Cost Estimator can help your practice navigate the No Surprises Act, get in touch with us today! 

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