While the “No Surprises Act” isn’t expected to go into effect until 2022, IONM companies that do not participate/contract with insurances companies need to be aware how the law may effect them.
When then-President Trump signed a $1.4 trillion year-end spending bill into law, included in it was the No Surprises Act. That act is a measure to end surprise medical bills for emergency as well as scheduled care.
Even without that law, there are 18 states which already offer comprehensive protections against surprise billing and 17 states that offer partial protections. There are 17 states that don’t offer surprise billing protections for patients. If you would like a list, contact me as that is not our focus here.
What exactly does the “No Surprises Act” mean for you? Many IONM companies are not contracted or participating with health insurances. This means that you “could” charge $1 million for doing IONM and the patient would be responsible for it all. I’m absolutely certain you don’t want to do that. HOWEVER, that is what it appears that you are doing to the outside world.
The patient will receive and EOB (explanation of benefits) from the insurance company as well as a check. Most of you know that the check is payable to the patient and he/she is supposed to sign it over to you, and many of the patients keep the money. However, the important part is that the EOB states you billed $1M and they paid to the patient $1,500. And it also tells the patients they are responsible for the balance. Of course, all they saw was the check and when they get a bill from you they freak out. THAT, is a surprise bill.
It doesn’t matter that they signed a form when they were in Pre-Op. In some states it may matter, but in most, it doesn’t. So, what does that mean? It means if the patient claims you balanced billed them and there is arbitration, the loser of the dispute (most probably you) will pay the arbitration fees.
Possibly one of the solutions to this issue by the government is to limit everyone, no matter whether they are in network or not, to have to accept the network pricing model. This means that you will be considered to be in network, whether or not you are contracted.
I would then highly suggest that you go ahead and get in network so at least the payment will go to you and not to the patient.
While it is a pain to sign up with all of the insurance providers, it is worth it. We here at MBA are more than willing to handle all of the credentialing and getting you the contracting papers with the insurances where all you do is sign the agreement. That is as simple as we can make it for you.
With what the government is trying to accomplish with this law, the cowboy days of charging anything you want and getting a pretty good reimbursement is going by the wayside.
We suggest you get on board with the insurance companies as fast as possible. Understand, credentialing can take up to 6 months to occur. Now would be the time to get started.
Sue A. Irwin, CHC, CHBME
Medical Billing Authority