Providers face penalties if they don't follow balance billing mandates and don't give patients a good-faith estimate of what a procedure will cost. Good-faith estimates are challenging because healthcare systems don't have the infrastructure to exchange information between disparate systems.
There were some states before the No Surprises Act that banned balance billing - in which patients get a bill for the difference between what the hospital charges and what their insurer pays. For self-insured companies and those under group health plans, the NSA federal rule treats balance billing differently. After a provider sends out a bill, the health plan pays, but there are several codes to let the revenue cycle know the claim is subject to balance billing.
CMS said it would exercise enforcement discretion on good faith estimates through the end of the year when the rule came out in 2021.
Revenue cycles are getting impacted by No Surprises Act issues, especially for emergency room doctors, anesthesiologists and other out-of-network doctors working at in-network hospitals. Curative Medical Billing is one vendor many providers are turning to for their solutions.
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