Surprise medical bills impact a significant amount of emergency room visits.
Since emergencies often require a quick solution, patients are not likely to search for in-network physicians. Unfortunately, that means visiting an out-of-network facility is often unavoidable for patients in emergencies.
According to USC-Brookings Schaeffer, when patients choose their primary physician and clinic for regular visits, they do not usually select their ancillary clinicians who might be a necessary addition to the team of physicians taking care of a patient. Then, the ancillary clinicians and emergency physicians receive a flow of out-of-network business from patients with little to no choice in the matter.
Intentional or not, they found a loophole, providing a solution to any loss of business they might experience due to not being an in-network provider for the patients’ insurance plan.
What the Act Means For Physicians
The No Surprise bill law prevents providers from surprise billing. Out-of-network providers must charge the patient the health plan’s in-network fee.
Implementing the No Surprise Bill law might cause some financial difficulties for some physicians if they are part of a smaller practice and do not have the necessary resources to use the IDR process to ensure they receive fair compensation. Adding this to the financial worries that resulted from the COVID-19 pandemic might make things a bit more difficult for some physicians.
Lastly, Congressional Budget Office (CBO) believes there will be noticeable reductions in new in-network rates resulting from the 2021 Medicare physician payment schedule.
How Does It Impact Physician Billing?
The No Surprise Bill law ensures that out-of-network facilities charge patients the in-network cost-sharing amounts designated by the patient’s health plan. However, the provider may dispute the cost-sharing amount through arbitration.