What is the No Surprises Act?

A Financial and Operational Guide for Healthcare Providers 

The No Surprises Act (NSA) is one of the most significant legislative developments in healthcare, aimed at protecting patients from unexpected medical bills. As it impacts both emergency and non-emergency services, the act has profound implications for healthcare providers and facilities, reshaping the way they manage billing, patient cost-sharing, and out-of-network services. 

In this article, we’ll break down everything healthcare professionals, revenue cycle leaders, and financial executives need to know about the No Surprises Act and its effect on operations, compliance, and financial performance. 

What is the No Surprises Act? 

Overview of Key Protections and Financial Implications 

Effective January 1, 2022, the No Surprises Act (NSA) is designed to prevent patients from receiving surprise bills for care they did not choose. The law applies to a range of services, including emergency care, non-emergency services at in-network facilities where out-of-network providers are involved, and out-of-network air ambulance services. 

For healthcare executives, understanding the financial and operational changes required by this act is essential. Facilities are now required to adhere to specific billing protocols to protect patients from excessive out-of-pocket costs, whether they seek care in-network or out-of-network. 

Impact on Healthcare Providers and Revenue Cycles 

Changes in Billing and Compliance Requirements 

The No Surprises Act imposes a range of responsibilities on healthcare providers and billing departments, including: 

• Emergency Services: All emergency services must be covered, even if the provider or facility is out-of-network. Patients cannot be billed for any amount beyond what they would pay for in-network care, with the exception of standard cost-sharing (co-pays, deductibles, etc.). 

• Non-Emergency Services at In-Network Facilities: If patients receive non-emergency care from an out-of-network provider at an in-network facility, the same protections apply. Providers must ensure that they follow the correct billing guidelines and cannot issue surprise bills to patients. 

• Air Ambulance Services: Out-of-network air ambulance services also fall under the NSA, meaning patients cannot be billed beyond in-network costs for these services. 

For healthcare financial leaders, adhering to these regulations requires robust systems to ensure compliance, timely submissions of payment offers, and careful documentation of patient cost estimates.  

New Requirements for Transparency in Billing 

One of the most impactful changes under the NSA is the obligation for providers to offer good-faith estimates for uninsured or self-pay patients before services are provided. If the final bill exceeds the estimate by more than $400, patients have the right to dispute the charges through a formal process within 120 days. 

For healthcare organizations, this means investing in systems that can generate accurate cost estimates and ensuring staff are trained to communicate these estimates effectively to patients. Failure to comply could not only result in financial penalties but also damage patient trust and satisfaction. 

How the No Surprises Act Works in Practice 

Common Scenarios and Financial Impact 

Here are some of the most common instances in which the No Surprises Act applies: 

1. Emergency Care at Out-of-Network Facilities: Patients who receive emergency services at an out-of-network facility will be protected from surprise bills, and providers must ensure they are not charging above in-network rates. 
2. Out-of-Network Providers at In-Network Facilities: Patients receiving non-emergency care at in-network hospitals by out-of-network specialists (such as anesthesiologists or radiologists) are shielded from surprise billing. 
3. Uninsured Patients: Providers must give uninsured patients a good-faith estimate of the expected charges before services are rendered. This estimate is legally binding, and patients can dispute any bill that exceeds the estimate by $400 or more. 
4. Air Ambulance Services: If a patient requires an out-of-network air ambulance, they are protected under the NSA from excessive billing. 

For healthcare executives, understanding these scenarios is crucial for adjusting revenue cycle management processes to ensure compliance with the act and maintaining financial health. 

Advantages and Challenges for Healthcare Providers 

The No Surprises Act offers several advantages for patients, but it also presents operational challenges for providers. Here are some of the key benefits and areas that healthcare financial leaders must focus on: 

• Improved Patient Trust: By protecting patients from surprise medical bills, healthcare providers can improve patient satisfaction and trust in the system. This has long-term benefits for patient retention and community reputation. 

• Reduced Financial Burden on Patients: Patients are less likely to face financially devastating medical bills, which improves their ability to seek timely care. This, in turn, can lead to better long-term health outcomes and reduce the burden of unpaid medical bills on providers. 

• Operational Challenges: Implementing the processes required to comply with the NSA—such as providing good-faith estimates, adjusting billing systems, and navigating disputes—can be resource-intensive. Providers must invest in technology, training, and new billing workflows to meet these requirements efficiently. 

 

The Future of the No Surprises Act 

State-Level Expansion and Federal Oversight 

While the federal No Surprises Act sets a national standard, several states are working to further strengthen the protections it offers. States like Colorado, New York, and Washington are enacting additional regulations to expand patient rights and enforce stricter guidelines on out-of-network payments. 

Healthcare systems must stay informed about both federal and state-level developments to ensure full compliance with the evolving legislative landscape. 

 The No Surprises Act marks a significant shift in how healthcare providers approach billing and patient communication. For revenue cycle leaders and healthcare executives, understanding and implementing the requirements of the NSA is critical to ensuring compliance, improving patient trust, and maintaining financial stability. 

If your organization is navigating the challenges of NSA compliance, Marcam can help. We offer solutions to streamline billing processes, ensure compliance, and support healthcare organizations as they transition to this new model.