Article originally published on Beckerspayer.com

Monday, December 12th, 2022 

Are Providers Ready for the No Surprises Act?

The No Surprises Act (NSA) had several top stories from 2022 including the recent Department of Health and Human Services (HHS) announcement that enforcement of a key requirement under the act would not start January 1, 2023, as previously scheduled.

With increased focus on the ability for components of NSA to be implemented, clarifying readiness of providers to participate is important.

The previous 2023 target date for the latest installment of NSA stipulated that affiliated co-providers would be responsible for producing their own Good Faith Estimates (GFEs). These affiliated co-providers practice in hospitals but handle their own billing (examples: anesthesiologists and pathologists). As part of NSA’s impact, the convening provider – defined in NSA as the facility/provider who schedules the service – would have taken the GFEs produced by affiliated co-providers and their own GFE and combine them into a consolidated Good Faith Estimate.

January 1 2023, convening and Co-Providers would have become equal partners in delivering GFEs to uninsured patients. When HSS ends enforcement discretion for this portion of NSA, this new partnership will include rigid turnaround times and expectations regarding the content and delivery of proper GFEs.

Are Co-Providers Ready?

Since the inception of pricing transparency regulations in 2020, affiliated co-providers have faced no regulatory scrutiny. All compliance responsibilities have fallen upon convening providers. As a result, the legal requirements of the No Surprises Act are not even on the radar of most affiliated co-providers. For the few who are aware, a series of delays and leniency from CMS has given the impression that enforcement will never come. This leaves affiliated providers inexperienced and unprepared to face impending NSA regulations related to consolidated GFEs.

In addition to lacking provider awareness to the regulation, CMS is incredibly particular about what information providers must supply and how it is presented. The complex and convoluted regulations are constantly changing and evolving as interpretations differ and legal questions arise. Healthcare providers truly require a dedicated team with the regulatory expertise to ensure that they remain in compliance. Unfortunately, many providers lack the bandwidth and resources to dedicate a team solely to CMS compliance.

Even more troubling, Co-Providers have not come to terms with their role as a convening provider if the patient contacts them directly. This is the point they are obligated by law to provide the GFE, including all disclaimers, directly to the patient. This is a burdensome process that Co-Providers are not prepared to address.

Are there existing solutions to upcoming NSA demands?

The shared creation of consolidated GFEs between convening providers and affiliated co-providers will require extensive communication, cooperation, and flexibility. Without established and shared management systems that document notification compliance within the strict timeframes, providers face the logistical nightmare of trying to coordinate and produce an already complex and now consolidated regulatory document.

However, lacking readiness of providers does not mean adhering to NSA requirements has to wait. Securing the proper workflow, communication, and documentation tools to meet NSA requirements is possible now. An existing solution is available from CorroHealth which seamlessly creates customized Good Faith Estimates (GFEs). This includes empowering affiliated provider entities to collectively produce a consolidated GFE and stand-alone GFEs for direct patient engagement.

By centralizing the upload of these documents, CorroHealth’s application manages and simplifies the logistics and communication between busy and understaffed healthcare providers, helping all parties to comply with both 2022 and 2023 NSA regulations.

Live education sessions with CorroHealth NSA experts are offered monthly. Join these sessions to discuss regulatory changes and their effect on various provider situations.

To learn more, visit corrohealth.com/nsa