Use Technology to Avoid Surprises From the No Surprises Act

As an industry, healthcare is moving from its highly complex, opaque landscape to one centered around transparency and delivering clear and straightforward financial experiences to patients. The No Surprises Act (“the Act”), which takes effect January 1, 2022, is another much-needed push for providers to be more transparent about total costs to the patient and eliminating the unexpected medical bills, typically referred to as balance billing, that two-thirds of adults consistently worry about affording. Balance billing occurs when a patient is unknowingly treated by an out-of-network provider and then billed for the difference between the provider’s charges and reimbursement received from payers.

The Act restricts out-of-network facilities and providers from balance billing. especially in cases where the patient was unable to choose an in-network provider such as being transported by ambulance to the nearest facility. While this often happens in emergency situations, balance billing can also occur when a patient visits an in-network facility for a procedure or service and is treated by an out-of-network provider, such as a radiologist administering an MRI.