If you haven’t heard of the No Surprises Act it is time to get acquainted with what the Act is and how exactly it will impact your laboratory. So exactly what is the Act? The No Surprises Act is a bipartisan law that was passed last year and effectively begins January 1st of 2022. This law protects patients from being hit with surprise medical bills which occur when a patient sees an out-of-network (OON) provider/facility. When the medical bill comes in, patients are shocked to find they’re expensive and immense but are still left to pay the remaining charges. With this new Act about to begin this will be a problem of the past for patients.

The Centers for Medicare & Medicaid Services reported that “Two-thirds of all bankruptcies filed in the United States are tied to medical expenses; one of every six emergency room visits, and inpatient hospital stays involve care from at least one OON provider, resulting in surprise medical bills.” These statistics are a staggering reality, and it was a current issue that needed to be resolved; hence the No Surprises Act, which now prohibits the patient from having to face financial responsibility and instead now prompts the payors and providers to settle it. As this Act places the burden on the providers’ and payors’ shoulders there is no telling if insurance premiums or contractual allowance adjustments will be affected, only time will tell.

Why are Laboratories Affected by This Act?

Under the No Surprises Act, some providers can supply patients with a Notice and Consent form. This form essentially lets the patients know they were notified that this provider is OON, and they will be subject to pay the fees for the service rendered. However, the Notice and Consent exemption does not apply to emergency services and nonemergency ancillary services: pathology, radiology, and anesthesiology. Laboratories also fall under the exemption status for the Notice and Consent and because of this, it will have a direct impact on laboratories.

How Will Laboratories Be Impacted?

The majority of small independent laboratories are not credentialed with health insurance companies, mainly because major laboratories like Quest and LabCorp already have ties with them. This means smaller laboratories will have to face the harsh reality that they will be considered OON resulting in the increased likelihood of denials with the consequence of placing more pressure on laboratories. Overall, for independent laboratories, this will put a financial, time, and administrative burden on them.

Now’s the Time to Partner with Credence Global Solutions

With the increased propensity for claim denials to skyrocket starting January of this year, it’s vital to have a standardized billing and claims process. With our simplified medical billing solutions, your laboratory billing process will be seamless and standardized. Here at Credence Global Solutions, we offer iConnect, our patient engagement platform that provides patient transparency and personalization when it comes to their medical bills designed to provide all laboratory companies a way to combat the No Surprises Act.