Taking effect January 1, 2021, the No Surprises Act (NSA) will protect patients (insured and uninsured) from surprise medical bills under certain circumstances. The NSA will affect how healthcare facilities, physicians, and non-physician providers are reimbursed for out-of-network (OON) services.
The NSA is part of the Consolidated Appropriations Act of 2021, which is a $2.3 trillion spending bill that combines $900 billion in stimulus relief for the COVID-19 pandemic in the United States with a $1.4 trillion omnibus spending bill for the 2021 federal fiscal year and prevents a government shutdown. The goal of the NSA is to provide transparency in billing and healthcare costs and hold patients liable for in-network cost-sharing amounts only.
Under the NSA, the burden will shift to the facilities, providers, and payers to negotiate payment well before a patient receives their final bill. The law also addresses additional protections for uninsured patients seeking care and what steps they can take if the medical bill is substantially higher than estimated in good faith.
The NSA does not apply to services provided in private physician offices, non-physician centers (e.g., physical therapy), or out-of-network facilities providing non-emergent care when patients are insured. However, the NSA requirements extend to licensed “healthcare facilities” adding rural health centers, federally qualified health centers, laboratory and imaging centers, and more for uninsured patients.
This new act will primarily affect how facilities bill and collect reimbursement. Under the NSA, the scenarios for the patient, facility, and provider will have very different outcomes as they relate to reimbursement from the payer and the amount the patient is obligated to pay for services out-of-pocket.
For additional information, please review the recently published white paper by CohnReznick LLP.