Handle NSA Complexities with A Perfect Out-Of-Network Billing Service 

The primary objective of the No Surprise Act is to safeguard patients from surprise medical bills, but it has made things complicated for healthcare providers like you. Healthcare providers have been dealing with high compliance costs, complex dispute processes, and significant loss of revenue related to out-of-network billing mechanisms since January 1, 2022. Many have seen reimbursements drop by nearly 40%. This well-meaning law has turned into a serious financial and administrative challenge for already overwhelmed providers. 

Let’s dig into the details of the No Surprise Act and why it rolled out.  

Learn what No Surprise Act is:  

The No Surprise Act is a federal law that safeguards patients from surprise medical bills. Now, you might be wondering how a patient receives surprise bills, right? A surprise bill typically occurs when a patient receives care from an out-of-network provider unknowingly. This particular law was passed through the Consolidated Appropriation Act of 2021. Patients only pay their usual in-network costs like copays, coinsurance, or deductibles in such cases. Providers can’t charge anything extra. The law also adds other protections, like giving good faith cost estimates to uninsured or self-pay patients, clearer info on insurance ID cards, better provider directories, and price comparison tools. It also assists patients when their provider leaves the insurance network.  

Now it’s time to know the reason why NSA was created. 

Why was the NSA created? 

Out-of-network billing often caused major problems for patients before NSA came into action. If someone got care from an out-of-network provider—especially without knowing—it usually meant their insurance wouldn’t cover the full cost. This led to much higher bills than if the care had been in-network. It happened a lot during emergencies or even at in-network hospitals where some specialists, like anesthesiologists or radiologists, were out-of-network. These surprise bills caused big financial stress. The NSA was created to stop these unexpected costs, make out-of-network billing more transparent, and help patients make better choices without fear of hidden bills. 

Unfortunately, out-of-network claims have been creating major roadblocks for most of the healthcare providers. Here are the vital challenges that you may often face as an out-of-network provider. 

Critical out-of-network billing challenges for healthcare providers:  

Financial impacts:  

The No Surprises Act (NSA) set up an Independent Dispute Resolution (IDR) process to help solve payment issues between providers and insurers for OON billing. But the system has many problems. There’s a huge backlog, with over 90,000 claims filed in just the first few months—way more than expected. Many providers feel the process favors insurers, which means they often get paid less. At one point, the fees to use the IDR process went up by 600%, adding more financial strain. Even though fees were later lowered, the process still takes up time, delays payments, and causes serious cash flow issues for providers. 

Legal obstacles:  

The NSA has already faced multiple legal challenges, and the Texas Medical Association also filed four lawsuits against some parts of this particular law. They questioned the fairness of the dispute resolution process, the heavy focus on qualifying payment amounts, and rules that lower those amounts unfairly. They strongly fought against the 600% hike to the IDR process under NSA. Some of these lawsuits have won in court, with federal judges agreeing that parts of the NSA unfairly favor insurers over providers. 

Heavy compliance burden:  

Healthcare providers are facing serious challenges in following the No Surprises Act (NSA). They must give good faith estimates, avoid balance billing, manage more admin work from the IDR process, and handle complaints. Did you know that almost 10,000 out of 12,000 NSA complaints have been filed against providers, related to surprise billing and estimate issues? Each case adds more strain and increases their workload. 

Although new laws may help soon—like the December 2024 bill aimed at fixing enforcement gaps—providers need quick solutions now to stay financially strong under the NSA. Here are some steps to consider. 

Vital out-of-network billing steps to implement: 

Providers should build strong appeal processes with teams that understand how the IDR system works. They also need to train staff forall NSA rules. Clear steps should be in place to spot and fix NSA issues early—before they turn into formal complaints. 

Unfortunately, most healthcare providers do not have a team of professionals who can handle out-of-network billing hurdles. However, you need a professional team that knows NSA rules well so that they can efficiently handle out-of-network claims.  

Professional out-of-network billing experts make the process easier for you. They start by reviewing the OON bill and estimating how much you can actually collect. Then, they suggest billing or coding changes to help you get the highest payment. They work closely with you during the first negotiation with the payer. If needed, they start the IDR process and follow up until it’s done. They also handle all the paperwork and submit the required documents. Once the final amount is decided, they make sure it’s paid into your account.  

Always select an out-of-network billing company that offers you zero arbitration fees, certified attorneys of staff and reasonable flat fees for all medical specialties.  

So, hire a perfect OON billing company today and enjoy the best outcomes from your out-of-network claims!