How Medical Billing Help You Avoid No Surprises Act Violations

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There is no question that medical billing is the most significant stressor for medical facilities. Regardless of how hard medical offices work, losing revenue is not uncommon because of the complex and tedious billing process. In addition, revenue loss can affect your business over time, whether because of inaccurate coding, an inefficient claims process, random denials, or a lack of on-time payments.
For these reasons, many medical facilities use a medical billing service. If you’ve considered using a service but haven’t decided yet, now might be the time to take action on it.
With the recent implementation of the No Surprises Act, many in-house billing offices are overwhelmed with the new rules and regulations. The No Surprises Act may be your reason to outsource your medical billing.

What Is the No Surprise Act?

The No Surprise Act 2022 is a federal law that protects consumers from receiving large “surprise bills” from their healthcare provider in certain circumstances.
The No Surprise Billing Act in summary protects consumers from:
– being charged for out-of-network providers that are located at in-network facilities
– surprise bills for emergency medical services at out-of-network facilities
In addition, the Act requires that medical facilities provide uninsured patients with a good-faith estimate of the cost of care.

Challenges of the No Surprise Billing 2022 Regulations

With the implementation of the No Surprises Act (NSA), the federal government estimates it will affect about 10 million out-of-network surprise medical bills a year.
Medical facilities have been scrambling to understand the specifics of the new law and how it would affect them. In addition, billing offices have had to learn the patient’s rights versus the medical facility’s.
As the Act states, doctors and hospitals cannot bill their patients more than the in-network cost-sharing amount for services covered by the No Surprises Act. If consumers feel their physician, medical office, or hospital did not follow the appropriate billing procedure under the NSA, they can file a complaint. A penalty of up to $10,000 can apply if the complaint is found to be valid.
The information is complex, evolving, and changing as patients, physicians, and healthcare plans work through the new process. The plan’s complexity leaves medical offices overwhelmed and fearful of getting a possible violation or penalty.

Benefits of Using a Medical Billing Service

Many medical offices, including physicians, labs, and hospitals, already outsource their medical billing. But now, with the implementation of the NSA, the benefits of outsourcing are even more apparent.
In addition, if you’re currently outsourcing your billing but aren’t happy with the results, this is a good opportunity to look for a billing company that meets your needs. Here are a few reasons why it might be a good time to outsource now.
You Don’t Have to Stay Updated About Changes to NSA
Although the NSA was implemented in January of 2022, many details and specifics are still unfolding. Because it is complex and evolving, it is hard for any medical office to stay updated.
A professional medical billing company will stay updated, so you don’t have to. Our experience can give you peace of mind and allow you to focus on patient care.

You Can Ensure That You Are in Compliance with the Regulations

A penalty of up to $10,000 can apply if a consumer’s complaint against a medical office is valid. So the overwhelming stress of compliance is unrelenting, especially if your office is unaware of the regulations.
The authority over NSA compliance will go to the individual states, but if the state doesn’t provide adequate enforcement, the Center for Medicare and Medicaid Services (CMS) will take over.
A good medical billing company will know the regulations and ensure that you are compliant with all NSA regulations, even as they may change.

A Medical Billing Company Will Address Challenges to Billing

The NSA allows consumers to challenge their bills if they feel they were charged incorrectly. However, with the current lack of education for patients regarding the NSA, your billing office could become overwhelmed with calls.
A good billing service will take over handling billing challenges for you. Not only do we know the NSA requirements, but we can address any concerns or questions with your patients directly.

Customized Billing Service that Is Unique to Each Medical Practice

While some medical offices only need a portion of their billing handled, others want their entire revenue cycle management (RCM) process outsourced. We can do both of those and every level of billing in between.

Personalized Support

Changes can be scary, so we try to make the process as seamless as possible. For example, if you have any questions about the billing of any particular patient, you will have access to a manager that you can contact.
In addition, you’ll have access to live phone support so that you can contact us at any time. The NSA regulations can be confusing, so we’re here to help.

You Can Focus on Patient Care While We Quickly and Efficiently File Your Claims

When a medical service is rendered, it’s essential to submit the claim as soon as possible. An in-house billing team cannot handle a large influx of claims and submit everything promptly.
Our team of experts submits claims within 48 hours in almost all cases. In addition, we have the latest medical billing technology that allows us to submit everything electronically, speeding up the claim process tremendously.
Being able to efficiently file your patients’ claims will ensure timely payment to you.

We Quickly and Aggressively Follow Up on Denied Claims

Claims are usually dropped because of rejections and denials. However, we follow up on rejections and denials as early as 15 days from the submittal date. We will do everything in our power to get your claim approved and paid.
Appeals for insurance denials are filed following the most current medical billing guidelines of the Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Academy of Professional Coders (AAPC), and the Affordable Care Act (ACA).

Your Patients’ Information Is Safe and Secure

Part of being a professional medical billing company is being 100% HIPAA compliant. When you share your patients’ confidential information with us, we will safeguard it from any security breaches or unauthorized access.
Medcare MSO has been in the business of medical billing for over a decade. That means we have adapted to many major as well as minor changes to regulations and insurer policies. Keeping up with the changing codes, regulations and procedures is standard for us. We always have the latest security and billing software to ensure we stay compliant and our clients do too. If you would like some relief from the stress of medical billing, give us a call at 800-640-6409 today.

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