New Patient Billing Laws and How to Prepare for Them

New Patient Billing Laws and What You Should Do to Prepare

New patient billing laws are here in 2022. They limit the ability to charge for out-of-network care, affecting billing practices across the country. The federal No Surprises Act, which bans surprise patient billing who receive care from an out-of-network provider in an emergency, is going to be disruptive. Additionally, several states, like Massachusetts, passed their own laws limiting balance billing practices. No matter where you are or which laws apply to you, we at PRL want to provide you with clear steps you can take to prepare your practice for billing changes in 2022.

The best way to prepare for mandated changes to your billing practices is to be proactive. Understanding how the No Surprises Act and other state laws will affect your workflow can give you a good starting point. Some changes you can anticipate are more documentation requirements, new reporting rules, and a heavier workload on your back-office staff.

Review your documentation processes and know where your strengths and weaknesses reside. Ask yourself a few questions too;

  • Are my documents consistent and well-organized?
  • What identifiable errors or empty fields are present?
  • Are your providers and staff assigning proper codes?
  • How often are your claims denied?

Now is the Time to Review Your Patient Billing Documentation Processes and Workflow

Start by reviewing your patient records for inconsistencies and errors. We suggest starting with a random sampling of recent records. If you find there are any issues present, develop a solution where you can remedy these problems. The most common errors are typos, incorrect billing codes, and outdated or inaccurate patient data. Essentially, you want to perform an audit on your records to identify any problematic trends. That way, if you need to adjust to new billing practices, your issues won’t be compounded by existing errors. 

The new regulations add another layer of complexity and room for error during documentation and billing. Practices are already at a higher risk of independent third-party audits performed by payers or the Office of the Solicitor General. Now, for Massachusetts providers and practices, the risk of hefty financial penalties adds to financial uncertainty. There is also a significant risk to your cash flow, claims submission, and reimbursements. The additional documentation requirements of the state and federal laws certainly have the potential to delay payments, which can increase a practice’s aging A/R days and compromise the flow of revenue into the practice. 

Remember, you don’t have to do this part alone. Performing an internal audit takes time, money, and resources. Instead of trying to audit your own records, consider partnering with a company that can do the heavy lifting for you. For example, at PRL we offer a really straightforward service called FitChart, where we perform an audit of your records and work with your practice to remedy any errors that we find. You can learn more about FitChart here.

Patient Billing: Experience is More Important Than Ever

There will be new reporting requirements within your billing workflow. Under the new law, patients have the right to request an Advanced Explanation of Benefits prior to receiving care. Your practice will also be required to provide patients with a good-faith estimate of treatment that will be covered by insurance and treatment where the patient bears financial responsibility. You must also be fully aware of the network status of each of your providers, as well as any other services like lab work. This is so you can provide patients with a complete overview of in-network and out-of-network care available through your facility.

Patient responsibility is increasing across the healthcare industry. Many patients lack full insurance coverage and may be turning to alternative payment models for their treatment. On top of all that, medical bills are becoming longer and more difficult to understand. The No Surprises Act and other billing laws will make this worse.

Patients will certainly have more questions about their bills. They also have more power and leverage to determine their exact costs of treatment. Staff who work in customer service, patient experience, or patient advocacy will need to be properly educated and trained on the new billing requirements as they are likely to be inundated with questions and demands from patients. Practices must invest in the appropriate resources to adequately prepare their staff. At PRL, we focus heavily on patient experience and self-pay because of shifting market and regulatory conditions. Our Patient Payment Xcelerator solution is certainly worth exploring if your practice needs a revamp to their patient services. You can learn about Patient Payment Xcelerator here.

It May be Time to Turn to an Outsourcing Partner

Then there is the issue of staffing. The healthcare industry is already grappling with a historical labor shortage. Doctors, nurses, and other healthcare practitioners report high rates of burnout and many are choosing to leave healthcare entirely. This also applies to back-office staff, who will have to address the bulk of new documentation requirements. Some practices already struggling to retain staff may find themselves needing even more labor just to keep up with the new surprise billing regulations.  

This may seem overwhelming, especially for smaller specialty practices that do not have the financial resources of larger institutions. Fortunately, providers and practices are not alone. The increasing complexity of medical billing has given rise to full-service RevCycle companies that devote themselves to increasing collections for their customers. RevCycle firms, including PRL, have diversified their service offerings as new regulations, shifting labor conditions, and new technology has increased the need for a more hands-on approach to medical billing.  

PRL works with Innovation, Commitment, and Integrity each day in order to improve healthcare for practices, providers, and patients alike. From staffing to patient experience to the actual processes of Revenue Cycle Management, PRL can provide physician specialty practices and ambulatory care facilities with a broad range of services. Increasingly, more practices are choosing to outsource their entire revenue cycle to PRL as the value of having an expert devoted to financial performance has increased notably. 

We strongly encourage any provider or practice facing uncertainty in the face of new surprise billing regulations to contact us and determine how PRL can partner with their organization to improve financial performance and patient satisfaction. Learn about how a full-service partnership with PRL can help your practice face the future of healthcare with confidence. If you, or anyone at your practice, is concerned about how the No Surprises Act or any state-based patient billing legislation will impact your revenue management, fill out the form with your question and we will connect you with one of our many RevCycle experts. 

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