The No Surprises Act (NSA) And What It Means To Medical Billing Companies

Anytime a new compliance requirement is in place in the healthcare industry, the medical billing companies have to gear up for intense learning and unlearning. Such companies play a pivotal role in protecting the legal statuses of their clients. Apart from matching the SLAs for reimbursements, these companies will also have to ensure their processes and strategies comply with the new law changes.

The No Surprises Act (NSA) has been implemented from January 2022, and this means the RCM billing companies and service providers have to be prepared to handle the change.

What is the No Surprises Act?

The No Surprises Act was proposed as a part of the Consolidated Appropriations Act of 2021, after the COVID-19 pandemic severely hit the commoners.

According to this act, healthcare providers, doctors, and other medical billing companies and service providers will not be able to pass on surprise, out-of-network medical bills to patients who opt for emergency treatments or treatments from an in-network healthcare provider.

Surveys say that one in every five emergency claims includes at least one part of an out-of-network bill, and one in six patients who opt for services from an in-network hospital end up with some out-of-network cost that their insurance does not cover.

NSA – things that change

From January 2022, patients now have to know beforehand if a particular service is going to be from an out-of-network provider. Also, services like neonatology, radiology, pathology, laboratory, and anesthesiology cannot be billed above the in-network sharing cost, even if the patient is informed about the same beforehand.

Two major takeaways of the bill are:

  • The patient will be liable only for their in-network  cost-sharing amount
  • The healthcare providers and the insurance companies have to work on negotiating the out-of-network amount via a separate resolution process

Why will it affect the medical billing companies?

The NSA will affect medical billing companies because of the workflow changes that hospitals and insurance providers have to make. Because of penalties of up to $10,000 that may be fined to hospitals for violating the policy, RCM service providers now have to be very careful with billing and claims.

Such service providers currently handle such out-of-network costs using balance billing. The No Surprises Act will outlaw balance billing in most states, and that means hospitals, medical billing companies, and insurance companies all have to make quick changes to their practices, so they adhere to the law.

The revenue cycle workflow will also change accordingly. Starting from identifying whether the state balance billing law or the federal NSA applies to a particular case, these medical billing companies have to calculate the shared costs and reimbursement rates, interact with payors, and handle negotiations with the insurance companies regarding out-of-network payments.

The responsibilities will certainly increase!

What can medical billing companies do to stay prepared?

The medical billing companies have to start by preparing themselves for the significant change. While only the compliance part has been explained as of now, other aspects of the law, including the independent dispute process and the rules and regulations for such negotiations, will closely follow. That means more information to learn and implement.

As an RCM service provider, be proactive and learn the latest happenings surrounding the NSA. There are going to be a lot of questions and innumerable needs for clarifications in the beginning. That’s why it will be good to check every claim and reimbursement request with more than one pair of eyes.

Learning and Development

The new laws and regulations may seem burdensome at first. However, there is nothing that a few intensive sessions of Learning and Development cannot ease out! Invest in L&D for your team in advance.

Most of these RCM service providers have already taken up training their employees to handle the new change. If you haven’t already, pick up the pace.

Technology and Automation

Technology is going to help here immensely. Quintessence relies greatly on two of our AI tools – Codessence and Reimburssence. Making ground-level changes to the functioning of these tools will help us handle NSA and all its compliance requests quickly and confidently. If you work with such RCM tools, then start by exploring how to customize these to match the new requirements.

Apart from tweaking your existing tools, invest in automation. Automating tools will make the learning and adapting process easier. Experts believe that the kind of used by these medical billing companies right now will be a game-changer. You can either grow amidst these erratic changes or fall back in the race based on the technology you have and are willing to use.

Invest in price estimator tools that can help make better financial decisions before opting for a treatment mode. Verification tools are going to be vital components too. Facilities need to know which service providers are parts of the patient’s network and which ones aren’t. Creating an automated verification process will bring down the risk of handling frequent negotiations and backend disputes.


The start of the pandemic brought about drastic changes in the healthcare industry, and as a third-party service provider, these changes affected us too. The No Surprises Act (NSA) definitely is the way forward, as it will bring down the burden of out-of-pocket expenses for patients and increase price transparency in the healthcare industry. It also prevents unfair termination of patient care, owning to out-of-network services.

However, just like how a new change takes time to get used to, the No Surprises Act will also add to the service provider’s administrative burden. Staying adaptive, being ready to learn, and remaining proactive will help you handle the transition smoothly.

Quintessence is already embracing the proposed law. We are making process and strategy changes to help our clients stay safe legally without compromising the reimbursement rates.

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