How the No Surprises Act is affecting practices: 3 compliance officers weigh in 

The No Surprises Act prompted many health practices and hospitals to act quickly to ensure they were in line with the law.

Although the No Surprises Act was signed into law on Dec. 27, 2020, HHS released its first interim rule for the act July 1, 2021, stating the implementation deadline of Jan. 1, 2022. The law is designed to prevent patients covered under group and individual insurance plans from receiving surprise bills from out-of-network providers and facilities.

Becker's reached out to compliance officers overseeing the implementation of the No Surprises Act to find out how practices and health systems were handling implementation. 

Question: How successful was the implementation of the act into practice, especially in the wake of this most recent surge? What worked and what are you still struggling with?

Deborah Dabbs. Compliance and Privacy Officer, Seminole Hospital District (Texas): I work for a Critical Access Hospital in a rural community. Our resources are slim compared to larger organizations. The act has put a strain on already strained resources. There is so much ambiguity in the act that it makes it hard for us to know what is required of us to comply.

We have done the best we can at implementation but I’m sure we are lagging behind larger organizations. We have our notices posted in our facility and on our website. We are in the process of training our employees.

Lori Hayden. Chief Compliance Officer, Commonwealth Pain Associates, PLLC (Louisville, Ky.): I am a department of one, which is not uncommon in a private, physician-owned medical office. We had absolutely no information except what was written, no guidance on what form and what type of notice until late 2021. Our saving grace has been our internal billing department since they keep our self-pay and uninsured pricing up to date and compliant.

So it wasn't necessarily difficult to create a policy and draft all that, but it was the actual implementation. How are we going to get these notices out in such a short time period? We are still having meetings about it. We pretty much have the practical side down, we posted the notice on the website, we have the notice in every patient room.

In essence, the NSA has not affected our current processes but has added more busywork to our already uber-busy practice. 

Josh Arters. Associate at Polsinelli (Nashville, Tenn.):  I have been assisting many large hospital systems prepare to implement the No Surprises Act, and one of the more difficult aspects of implementing the act is establishing procedures to facilitate the delivery of good faith estimates. Hospital administrators support the idea of giving their patients an expectation of the cost of their care; that is not the issue. Instead, implementing this part of the act is difficult on a practical level because it requires hospitals and independent physician practices to work together to generate a single good faith estimate of all charges in a short amount of time. Most hospitals and physician practices did not previously have the administrative processes in place to accomplish this, so many had to start from scratch. One thing that has worked is opening the lines of communication between hospital administrators and physician groups early, so that each party knows their responsibilities and expectations. But one area that is an ongoing struggle is determining how to have processes in place to deliver the good faith estimate itself. The act requires that the good faith estimate be delivered to the patient in writing according to the patient’s preferred method of delivery, and in a relatively short amount of time to boot. Operationalizing this requirement on a systemwide level requires thoughtful consideration.

Of course, the most recent [COVID-19] surge hasn’t helped. Hospitals and physicians have lived on the front lines of the pandemic for nearly two years, and implementing such sweeping changes during a pandemic is certainly difficult. But most hospitals have risen to the challenge.

Q: What do you wish you would have known before implementation?

DD: It would have been really nice to have more clarification on what is considered our "network" or "partners." In a rural community that has a large service area, just how far out would CMS consider our "network" for the purposes of obtaining costs for the good faith estimate. And if the patient goes to their hometown, 30-50 miles away, to get those services are we responsible for asking the patient where they will get the services, call the provider, and get the costs? Or are we only responsible to give them the costs if they got their lab done at our facility or used our outpatient pharmacy?

LH: As a privately owned physician practice located in multiple states, we would have greatly appreciated additional time and guidance prior to the start date of the NSA. It would have been very helpful to have the dedicated CMS NSA help site up and active six months prior to the hard and fast implementation date so we could double check our internal policies and notice forms against the CMS suggestions. 

JA: That there is sometimes no "one-size-fits-all" solution to the act’s implementation. The way the new law may apply to a particular hospital within a system can vary depending on its location, payer mix and patient population.

Q: What advice would you give to other hospitals/health systems adjusting to the changes? 

DD: Share knowledge. Thankfully because I worked at a larger facility before coming here I have contacts that are always willing to help. It is nice to know I have people willing to help me support our community hospital.

LH: In practicality, I think sometimes you can get bogged down in the word of the law and you miss out on the spirit of the law.  Everyone sees we have this new requirement, everyone you know, kind of takes a deep breath like, "Oh, how are we going to fit this in?" 

The beauty of being older and working in healthcare is you create these connections as you go along and you can bounce ideas off of other people, especially in the compliance community.  So of course I reached out to other colleagues at different practices and asked, "Hey, what do we need to do?" It was so key. 

JA: Adjusting procedures to implement every aspect of the new law requires coordination from many departments across a hospital’s administration. From scheduling, to billing, to revenue cycle, to finance, to payer contracting. It is important that each department understands how the new law impacts hospital operations and to communicate early and often as hospitals work out the kinks in the new law as they arise.

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