The New Surprise Bill: What Is Its Impact on the Balance Billing?

The new federal rule regarding surprise medical bills has a lot in store for the medical practices. And, the organizations have to be ready for it as the law will take effect from next year, January 2022.

Hospitals and medical billing services on their behalf have to be extra careful as the practice of balance billing have been permissible. Realistically, health It leaders and relevant hospital administrations have to implement procedures, including proper permissions and formal notices, otherwise, we will have to go on like this with a poor collection process.?

What is Balance Billing??

Balance billing refers to the claims that physicians or billing companies send out to patients with the differences between the approved payment and the expense of rendered services. In simple terms, it is the out-of-pocket expenses that patients have to pay, and America has been dealing with this situation for quite some time.?

High Healthcare Expenses Related to Surprise Bills Paved Way for New Legislation

Many American states already have rules in place to cut down costs for surprise medical billing. However, most of these rules do not apply to the commercial insurance groups that insure private office employees.?

Amidst all this, the conflict between state and federal regulations is meant to happen. For instance, some states do not allow surprise bills at any cost even if the patients are informed about their financial obligations beforehand the rendered service.?

The Impact on Healthcare Industry with Post-Stabilization Services

The new law will prohibit surprise billing for emergency care services. It states the additional cost must be settled between clinicians and insurers if a patient receives emergency healthcare service either at an:

• Out-of-network facility?
• Or Out-of-network provider at an in-network facility

There are certain criteria that clinicians have to meet in order to accommodate surprise bills in post-stabilization services. We are going to find them out in this article.

All About the New Rule?

Emergency Attending Clinician Must Determine the Patient's Traveling Status?

The rule states that the clinician catering to the emergency or treating healthcare provider must determine if the patient can travel with nonmedical transportation or non-emergency medical transportation to the provider's location within a reasonable distance.

Clinicians also have to consider several other factors, such as access to transportation.

Rule Requires a Proper Consent from Patients

The patient has to follow the notice-and-consent procedure if the patient wants to receive post-stabilization services on an out-of-network facility even if they can travel. Only then, the patient can be liable to pay the out-of-pocket expense.

Providers must have a standard notice issued by the U.S. Department of Health and Human Services (HHS). Also, it must have a consent document separately attached to it.

We have seen some states, which allow clinicians to take consent on patients' behalf. The new rule prohibits it. It disowns its implication in any case.?

Financial Liabilities Must Be Conveyed to Patients At least 72 Hours Prior to the Appointment?

Yes! The federal surprise billing rules advise providing patients with all the surprise billing details at least 72 hours before the appointment. In an otherwise case, patients must know about it on the day of the appointment.

However, the clinician or medical billing service must ensure if the patient is fit to make the consent decision.

Give Patient Proper Time to React to Consent Form

The new legislation seems to be quite pro-patient and supports patients in all matters.?

For instance, it also pays attention to a situation where a patient instantly goes for post-stabilization services and has to make an informed decision. The turnaround time matters a lot in this regard. So, the law enforces that it is not necessary to force patients for immediate decisions at all.

So, all in all, medical billing services won’t be able to surprise bill, even if they have taken consent from the beneficiary of services. A lot has to be taken into consideration for it.

Now, the feedback on the federal law taken by HHS would determine how much impact we can anticipate in the upcoming year or if things will not turn out as expected. Let’s see how it goes.