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Is Your Healthcare Business In Compliance With The No Surprises Act?


At the beginning of 2022, the No Surprises Act took effect.  This law aims to reduce the burden of unexpected medical bills on consumers.  According to the new law, when a patient seeks treatment on an emergency basis, all the providers who dealt with the patient during the emergency visit and hospitalization (if any) must charge the patient the same rates that in-network providers would have billed the patient.  For patients, this means that ten million medical bills each year will be for amounts that the patient could have anticipated, based on their health insurance policies, instead of for hundreds of dollars per provider and more than a thousand dollars per emergency room visit.  For healthcare providers, it means negotiations with insurance companies about paying additional amounts beyond the patient’s responsibility; the No Surprises Act provides for an arbitration process for providers and insurance companies to agree on payment amounts.  If you operate a doctor’s office, medical lab, or other business, you will need to comply with the new law.  A Washington DC small business lawyer can help you resolve disputes related to this.

How the No Surprises Act Affects Medical Labs

Pursuant to the No Surprises Act, anesthesiologists, radiologists, and hospitalist physicians (the doctors who see patients in the emergency room) must bill patients at in-network rates whether or not the healthcare provider is in the patient’s insurance network.  This rule does not apply to medical labs, however.  The No Surprises Act contains a loophole where medical labs can charge out-of-network patients out-of-network rates.  If a patient visits an in-network doctor, and the doctor sends the patient’s blood samples to an out-of-network lab for analysis, the lab can still bill the patient for the out-of-network amount.

How the No Surprises Act Affects Urgent Care Clinics

Emergency room visits are the biggest source of surprise medical bills asking for amounts that the patient cannot afford to pay.  In order to mitigate their costs, many patients visit urgent care clinics instead and only go to the ER if their doctor has told them that the symptoms they are experiencing warrant an ER visit.  Under the No Surprises Act, urgent care facilities should charge patients in-network rates regardless of which insurance provider the patient has.  Of course, urgent care centers do not have to follow this rule unless they are licensed as emergency service providers.  Therefore, even if you treat most of your patients on a walk-in basis, those visits might not count as emergency medical services, and you might not have to follow the in-network billing rule.

Remember that, under the No Surprises Act, healthcare providers still have the right to get paid.  It is just a matter of deciding which amount is the responsibility of the patient and which is the responsibility of the insurance company.

Contact Tobin O’Connor Concino P.C. About Disputes Over Medical Billing

A Washington, D.C. small business lawyer can help your medical practice collect payment pursuant to the No Surprises Act.  Contact Tobin O’Connor Concino P.C. in Washington, D.C. or call 202-362-5900.



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