August 6, 2019

Get to Know the ‘Surprise Billing’ Bills

Patients have long been collateral damage in the spats between insurance companies and providers. But with recent political attention on ‘surprise’ bills, your patients are about to become even more aware of the issue, regardless of the outcome in Congress.

This awareness is probably a good thing for your patients, but it does present a challenge for providers: how do you react to inevitably higher expectations around transparency and the patient financial experience? To answer that question, let’s take a look at the proposed legislation and strategies proactive providers should be considering to get in front of the coming changes.

Cassidy and Hassan: Senate Surprise Billing

Introduced in May and titled the “Stop the Outrageous Practice (STOP) of Surprise Bills Act of 2019,”  this bill tackles billing surprises head-on. It intends to prohibit surprise balance billing and address the following scenarios:

  • Patients receiving emergency care at an out-of-network facility or from an out-of-network provider
  • Patients receiving healthcare services from out-of-network providers at in-network facilities
  • Patients receiving additional healthcare services after emergency care at an out-of-network facility when they would require medical transport to receive care at a different facility

The bill also addresses cases where patients receive out-of-network lab or imaging services ordered by an in-network provider, only leaving them liable for in-network cost-sharing and patient-cost sharing.

The bill additionally states that providers and plans that violate the ban on surprise billing could be subject to civil monetary penalties. In situations where the ban does apply, doctors would automatically be paid a preset amount based on what other plans in the area are paying for a similar service — the “median in-network rate.”

The Strategy

This is a shift that many patients might not fully understand, so it’s worth rethinking your billing communication strategy. If the act does go into effect, it will add an extra layer of complication, and in some cases, it will be worth considering adjusting your bill layouts to explain when the act is in effect, how it works, and how a bill was impacted.

“No Surprises” Act

The House is doing similar work with the “No Surprises Act” taking center stage. Similar to the “STOP” Act, this bill would additionally require healthcare facilities to give patients receiving elective treatment 24-hour notice that they will be seeing an out-of-network provider. Providers would be prohibited from balance billing patients in these scenarios.

The primary difference between the two proposals is that the “No Surprises Act” gives providers a mechanism by which they can challenge the basic median pay rate, opening up a 30-day window to initiate a dispute resolution. The bill (which has advanced out of committee) would exempt patients from being involved in disputes.

The Strategy

Since this bill potentially mandates 24-hour notice but allows for written and oral notice and consents, providers who aren’t prepared for time-constrained communications might need to reconsider their approach to patient contact.

If this does seem like it will be a challenge, consider conducting surveys to identify the best way to connect with your patients. This will ensure you’re maintaining compliance while communicating in a way that patients will actually receive and understand.

The Senate: Alexander and Murray Healthcare Bill

Coming out of the Senate Health, Education, Labor, and Pensions Committee, this legislative package takes a somewhat broader stance. While it addresses surprise billing, it also makes direct stipulations around patient communication.

Once a patient is stable and lucid after an emergency, providers would be required to give written notice that a patient is about to be treated by an out-of-network doctor, along with an estimate and a list of in-network providers where they could alternatively seek care. The bill requires that the notice be short, easy-to-read, and clearly specify that seeing the out-of-network doctor is optional.

If a patient isn’t given this notice, they can only be billed the in-network rate.

The Strategy

This bill will require sophisticated estimation capabilities in addition to a new approach to patient communication design. The demands of this legislation will require providers to rethink engaging communication design and prioritize effectiveness in new ways.

While We Wait

We’re still waiting to see how each of these bills plays out, but regardless of the outcomes, this is an opportunity for providers to position themselves as information allies.

You can start that process today by letting your patients know that you’re keeping up with developments and adjusting your communication and revenue cycle processes to accommodate their needs. Most importantly, make sure you’re integrating these new communication requirements into a personalized and consistent patient financial experience.

RevSpring Can Help

Integrated payment communication is part of RevSpring’s DNA. We tailor the payment conversation to influence behavior and inspire action. Our segmentation rules and workflows help you become hyper-focused on the patient, understanding their ability to pay, and mapping their financial obligations to repayment pathways.

If you’d like to learn more about our comprehensive patient engagement and billing solutions, we’d love to help you. Request a demo to see how we can help your organization meet its goals.