On December 27 last year, a new law was signed which is dedicated to providing healthcare protection nationwide. H.R. 3630 or The No Surprises Act (NSA), has become a boon for patients struggling with high unexpected medical bills. Although this is good news for patients, healthcare insurers and providers must hustle to adjust systems, and technological capabilities to comply beginning January 1, 2022.
- A concern regarding compliance: According to a recent survey by Zelis, the leading payments company in healthcare, nearly all insurers expressed concern about the ability of the healthcare system to achieve compliance with the NSA by the deadline. While some states – Colorado, New Mexico, Texas, and Washington – have existing balance billing laws to protect patients from unexpected and excessive healthcare costs, the NSA brings more complexity to the pricing, negotiation, and settlement, and arbitration processes at a national level.
- Results of the survey: In the survey of more than 100 executives representing 85 U.S. healthcare payers, it is found that more than a majority are concerned about adhering to the timelines required and transparency requirements. More than one-third expressed concern about setting the appropriate reimbursement levels, managing the Independent Dispute Resolution process and provider directory requirements.
- Demand for dissection of law: “The No Surprises Act impacts all healthcare organizations, from large health plans and systems to small medical offices and individual providers,” said R. Andrew Eckert, Zelis CEO. “Like Zelis, leaders across our industry are convening to dissect the details of the legislation because understanding the law and implementing it are equally important. Insurers will need tools and to invest resources into operationalizing the requirements.”
- Necessary alignment: Alignment with the NSA requirements will require companies to adapt internal capabilities or outsource solutions. Companies may have to alter their infrastructure and processes to administer all aspects of the law.
- A healthcare payment platform: Zelis was founded on a belief there is a better way to determine the cost of a healthcare claim, manage payment-related data, and make the payment because more affordable and transparent care is good for all of the USA. They partner with more than 700 payers, including the top-5 national health plans, Blues plans, regional health plans, TPAs, and self-insured employers, 1.5 million providers, and millions of members, enabling the healthcare industry to pay for care, with care.