4 challenges your administrative team may face in 2022 due to the No Surprises Act

April 20, 2022

The No Surprises Act is a new bill designed to help protect patients from unexpected costs related to their health care. It applies to patients who are paying for their care without insurance. The majority of the bill focuses on emergency situations. But the No Surprises Act affects health care providers of all kinds, including providers of physical therapy. While this new law may present some challenges, the new requirements will benefit both patients and providers in the long run.

According to the No Surprises Act, health care providers must give all self-pay patients an estimate of their expected costs. This includes patients whose insurance does not cover a particular service, provider or practice, as well as patients who have no insurance coverage at all. These estimates, known as good faith estimates, help to alleviate fear of surprise bills or extra costs after treatment.

What are some challenges presented by the No Surprises Act?

The No Surprises Act benefits patients by providing them with the information they need to make informed decisions. It also benefits providers by building trust between the patient and the practice. However, the new law presents physical therapy practices with a few hurdles that they will need to overcome to stay compliant:

  • Providing accurate estimates — There are many factors that can affect the cost of physical therapy. Your practice must account for any unforeseen costs that may occur. These may be due to your patient’s physical condition, injury risk or other personal circumstances.
    • If a patient’s costs exceed $400 more than their good faith estimate, they will have the right to dispute the costs. That might leave your practice responsible for covering unforeseen expenses. Accounting for possible costs beforehand will help your practice provide more accurate estimates.
  • Informing patients of their rights — Many patients may not have heard of the No Surprises Act. They may not know that they have the right to dispute unforeseen medical costs, and this can place them in financial hardship.
    • Informing your patient of their right to a good faith estimate helps save your patient’s money, and it will reinforce their trust in your practice. Patients are more likely to return to your practice if they believe that you have their best interests at heart. It is also important to inform patients that a good faith estimate is not a contract. It does not create an obligation to receive services from your practice.
  • Keeping patient records — The good faith estimates required by the No Surprises Act are more than simply estimates. They are considered a part of the patient’s medical history. Providers are required to keep a patient’s estimate available upon request for no less than six years.
    • However, the estimate is considered to have expired if more than one year has passed since the date the estimate was given. If a patient wishes to seek care after that date, they will need to be provided with a new estimate.
  • Keeping insurance providers informed — Another rule of the No Surprises Act is that insurance providers are required to update their provider directories every 90 days. This helps patients more easily find providers who are covered under their insurance network. It also helps to avoid unexpected costs from out-of-network providers.
    • Health care providers are required under the new law to notify all insurance providers of any changes to their listing. This can include the addition of new specialists or the removal of previously offered services. Insurance providers are then required to inform a patient if any of these changes affect their coverage, or their ability to seek care.

How can I best prepare my practice for the changes caused by the No Surprises Act?

If you are worried about remaining compliant under the No Surprises Act, let Alliance Physical Therapy Partners help. Compliance and billing assistance is just one of the many ways that Alliance PTP can assist your practice. Our goal with every one of our partners is to offer the support and resources needed to make your goals a reality.

Partnering with Alliance means you have access to a compliance program that can proactively identify potential risks, but also ensures that your physical therapy practice is meeting all standards and requirements at all times.

 

Contact our team today for more information about how we can help your practice or to find out how you can join our partnership in care.