The Centers for Medicare and Medicaid Services (CMS) has released a comprehensive report detailing its enforcement efforts under the No Surprises Act (NSA). Since its implementation, the NSA has led to more than 16,000 complaints, with nearly 12,700 cases already resolved. In about 8.2% of these cases, violations were found, resulting in over $4.18 million being paid to consumers and providers as compensation for non-compliance.
What can you do to increase your NSA compliance? Read on to learn about this important medical billing topic and how to protect your company from costly violations and ensure smooth billing operations.
What Are Common No-Surprises Act Compliance Violations?
The report revealed that non-federal health plans and insurers often violate certain aspects of the NSA. The most common infractions include:
- Non-compliance with Qualified Payment Amount (QPA) standards
- Delayed payments after Independent Dispute Resolution (IDR) rulings
- Failure to meet the 30-day payment or denial notice requirements.
Providers, including healthcare facilities and air ambulance services, were also found in violation of the NSA. These violations typically involved surprise billing for non-emergency services, emergency services, and errors in good faith estimates.
How Does the Independent Dispute Resolution (IDR) Process Work?
The IDR process, a key component of the No Surprises Act (NSA), is vital in resolving payment disputes between healthcare providers and insurers over out-of-network services. When disagreements arise about the payment amount, an independent arbitrator reviews both sides’ arguments. The decision considers several factors, including the Qualifying Payment Amount (QPA), the complexity of the case, and the provider’s experience. This process helps ensure that providers receive fair compensation without burdening patients with surprise medical bills.
Understanding the IDR process is essential for medical billing companies, as non-compliance with NSA requirements can lead to costly delays, penalties, and reputational damage for their healthcare clients. Many health plans fail to make timely payments following IDR rulings, which can result in financial strain for providers. If your medical billing company handles these disputes in-house, the administrative load can become overwhelming, especially as your company grows.
Outsourcing denial management and A/R follow up to a partner like 4D Global can streamline your processes and ensure that IDR disputes are managed efficiently and fully compliant with NSA regulations. By leveraging the expertise of 4D Global, your medical billing company can focus on scaling its operations while avoiding the costly pitfalls of NSA non-compliance. Working together, we can improve your clients’ financial health and strengthen your position as a reliable billing partner capable of handling intricate regulatory challenges.
How Can My Medical Billing Company Prevent No Surprises Act Compliance Violations?
Several of the violations reported by CMS are preventable if the proper procedures and expertise are in place. For example, late payments and errors in good faith estimates are often due to inefficient billing processes. Maintaining efficiency while scaling a medical billing company is a careful balance.
The partnership 4D Global shares with our clients helps them avoid penalties and keeps their growing clientele satisfied by preventing surprise bills—one of the main goals of the NSA. If your medical billing company is seeking to expand your services and specialties, having a Revenue Cycle Management resource like 4D Global allows you and your team to focus on your business development and client success goals while leaving complex compliance issues to the experts.
Let Your Compliance Be a Top Priority with 4D Global.
As the CMS continues to monitor and enforce the No Surprises Act, medical billers must maintain compliance diligently. Compliance with the NSA is not just a requirement but a top priority that should be at the forefront of every healthcare provider and medical biller’s mind.
Contact us and learn how we can work together to avoid common pitfalls, reduce violation risks, and focus on delivering accurate and efficient client services. With proper support, your medical billing company can better handle the regulatory complexities of the NSA, ensuring compliance and financial stability for a bright future.