Since the No Surprises Act went into effect January 1, 2022, the rollout has been full of surprises. As healthcare organizations attempt to interpret what must be done (and how) amidst ongoing lawsuits, compliance is easier said than done.
While healthcare systems might not be able to get pricing estimates perfect every time, aligning internally around strategy and messaging, communicating good intentions and values externally and educating patients about their rights at multiple touchpoints will lead toward a path to success in the long run.
Here are the four topics you should revisit with your revenue cycle team as you continue your work to meet the demands of the No Surprises Act.
Do you have a big enough team to comply?
Many organizations felt understandably overwhelmed by the rollout, having already scrambled to deal with staffing shortages, financial difficulties, and other issues that arose as a result of the pandemic.
“My revenue cycle team felt a bit underprepared when this came out,” says Christine Hayek, Assistant Vice-President of Digital Experience and Innovation at AtlantiCare. Having been focused on COVID, as well as price transparency work, along with having converted to a new physician billing company, her team was a little overwhelmed by the rollout. However, prior to the NSA rollout, Christine’s team had been strategizing on how to create a better digital consumer experience—which is now at the top of the priority list given the legislation.
Do patients even know about the NSA?
The fact is, many patients are not aware the No Surprises Act exists. That’s a problem. They may wish for an end to unexpected medical bills, yet they do not realize that the NSA actually gives them certain legal protections around healthcare costs. Healthcare organizations around the country must do more to get the information out in front of patients, whether it’s highly visible on an organization’s website, raised during conversations with providers, included in email newsletters to patients, presented on office posters, or distributed as pamphlets with “FAQ” sections. Clearly, more promotion is needed, in any way that budgets can accommodate.
Initially, says Sheila Augustine, Director of Revenue Cycle, Nebraska Medicine, most of their patients had no idea about the NSA. “That’s probably an area where we were not the best equipped,” she admits. “We didn’t really get our staff educated to explain it well. In the beginning, it was just, ‘Here’s a flier, please read it.’” Since then, they are working on improving communication and getting patients up to speed on the rollout.
How should you add context to price estimates?
Providing patients with reliable good faith estimates means more than checking off box and declaring that it’s done. It means building out the right technological processes, which remains a work in progress for many healthcare systems. Patients need more than a confusing alphabet soup of numbers—they need the context to make sense of it all. For instance, breaking down the amount for a consultation, another for lab work, and another for medical supplies needed (such as a knee brace). Those kinds of details help to build trust with patients, and ultimately help alleviate unnecessary call center activity, too.
Yet the truth is, giving out good faith estimates can be tough to achieve, and easier said than done, especially for certain procedures. In radiology, for example, historical data can vary widely when used for reference in providing future estimates. That pain point can lead to confused and frustrated patients who may even cancel appointments because of what they perceive as inaccurate or misleading estimates.
“There’s a disclaimer in these good faith estimates about ‘anticipated’ and unanticipated’ services. And yes, the question is, how much do we know?” says Zakiya Devine, Senior Director of Patient Financial Clearance, Children’s Hospital of Philadelphia (CHOP). “How accurate can I get this estimate, relative to what’s expected in this regulation and the reality of healthcare? You come in as a patient and present one way, versus what it was when you scheduled the appointment. We’re really trying to balance how to give a precise number.” The goal, she says, is to be as exact and comprehensive with information as possible for every single patient.
Ideally, patients will not only be able to obtain (fairly accurate) good faith estimates via a user-friendly online patient portal, but given the context for each of those estimates. For instance, for a knee injury, there should be no confusion around which estimate refers to specialist visits, versus emergency care or X-ray services. Patients must be able to comprehend not just the numbers, but the why and where behind them.
How can you avoid a revenue cycle silo?
As is true in dealing with all crises and roadblocks, large or small, communicating clearly, openly, and often is the way to go, and that is certainly true for grappling with the NSA.
John Freeman, President and CEO of Revigate, a firm that provides revenue cycle management and consulting services, is accustomed to helping organizations navigate choppy waters. He emphasizes the importance of communication and collaboration in navigating the NSA rollout. “What I’ve seen work well is for health systems to not approach the No Surprises legislation in a revenue cycle silo,” he says, “but to open up a cross-functional team that’s inclusive of your IT and technological vendor partners, and your compliance, risk, and legal functions within the organization—because this legislation is a bear. It’s complex. It’s 700-plus pages. There is a lot of ambiguity and gray areas that are left up to interpretation.”