Utilizing Tech to Improve Patient Experience Amid the No Surprises Act

ith the No Surprises Act taking effect in less than four months, it is critical that hospitals and providers leverage technology to ensure patients are informed about their expected care costs prior to receiving services. Despite industry improvements in the last several years, there remains a pressing need for more meaningful price transparency in healthcare. The No Surprises Act, in addition to recent revisions to existing Centers for Medicare and Medicaid Services (CMS) price transparency regulations1 and a policy push by President Biden2, aims to continue the trend toward more patient-centric healthcare that makes it easier for patients to navigate the inherent complexity.

On July 1, the Department of Health & Human Services released the first of three regulations that clarify key portions of the No Surprises Act. In the past, many patients have received unanticipated bills for emergency services or from out-of-network providers who provided services at the patient’s in-network hospital. The No Surprises Act prohibits healthcare facilities and providers who are outside of a patient’s insurance network from “balance billing” except under certain circumstances. For example, under the new requirements, an out-of-network anesthesiologist who participates in a surgery or an emergency department physician who cares for a patient may no longer balance bill when these activities occurred at a patient’s in-network hospital. Unless the patient receives notice and provides written consent3, providers may generally only collect cost-sharing amounts that would have been charged had the patient been in-network. This notice and consent process also requires out-of-network hospitals and providers to furnish “good faith estimates” to patients of their expected charges.