How the No Surprises Act affects ambulatory surgery centers + Ways to navigate the changes
The No Surprises Act has changed how medical professionals work and care for their patients. Chris Finelli, HST Pathways’ vice president of business development, shared with the Texas Ambulatory Surgery Center Society (TASCS) the main attributes of the act that went into effect on January 1, 2022.
The No Surprises Act eliminates the unanswered questions in healthcare billing by requiring medical providers to give timely good faith estimates to patients for healthcare services. Finelli said that the law requires price transparency from all medical professionals and provides a way for consumers to "shop" for medical services. These services focus on uninsured and self-pay patients and any patient who asks for the estimation of services. There’s a possibility for these estimates to extend to all patients.
Finelli focused on the point that ASCs are not exempt from the No Surprises Act and are considered a convening provider in the system, responsible for providing estimates for primary services. These estimates allow for clear payment expectations, time for patients to prepare their finances, and a decrease in Americans filing for bankruptcy because of high medical bills.
Two components that help medical organizations provide the best estimate possible include clarity and transparency. One example is maintaining accurate provider/payor estimates with easy-to-use programs. These estimates are created with online tools and can be easily delegated to health companies that will provide an estimated price sheet for all consumers. Finelli shared that organizations like Clariti (HST Pathways’ patient estimation tool) and SmartHealth PayCard can help ASCs with management systems to create the best experience for both the provider and the patient.
Another suggestion was that ASCs should include a self-pay or out-of-network pay calculator on their websites. By making it easily visible, payors can calculate the amount of potential medical procedures. The pay calculator can help eliminate the need for arbitrators to negotiate medical payment disputes, whether federally or within the state of Texas.
All in all, these upfront views of potential medical costs alleviate the anxiety of potential bills, lead to better financial planning, and help ensure a positive relationship between medical providers and patients.
