In response to ongoing challenges within the No Surprises Act (NSA) framework, Rep. Greg Murphy (R-NC) and colleagues have introduced new legislation to close existing loopholes and enhance patient protection.

This proposed bill (H.R.9572) focuses on increasing penalties for group health plans and health insurance providers who violate balance billing regulations, ensuring that patients are not burdened by surprise medical costs. While the 2020 NSA made significant strides, there remain gaps that allow patients to face unexpected bills, particularly in cases of out-of-network care.

The Role of Employers in NSA Compliance

Employers play a pivotal role in ensuring that their group health plans comply with the latest NSA regulations. This involves educating employees about their rights under the law, reviewing plan designs to minimize out-of-network exposure and maintaining transparency in billing practices.

Employers who fail to comply with NSA regulations risk facing significant penalties and their employees could end up facing the very surprise medical bills that the law is designed to prevent. It is essential for employers to stay informed about the latest legal developments and ensure their health plans are fully compliant.

How aequum Can Help

aequum provides employers with the tools and guidance needed to navigate the complexities of NSA compliance and protect their employees from surprise billing. Here’s how aequum supports employers:

• Legal Compliance Support: aequum’s team of legal experts monitors ongoing legislative changes and ensures that employers stay up to date on NSA requirements. This helps employers adjust their health plans accordingly to avoid non-compliance penalties.
• Claims Dispute Resolution: aequum assists in resolving balance billing disputes, offering representation in arbitration processes and working with healthcare providers to ensure fair claim settlements. This service reduces the administrative burden on employers and prevents employees from being drawn into costly disputes.
• Employee Education: aequum empowers employees by educating them about their coverage, providing resources to help them understand their rights under the NSA and offering support with managing their medical bills. This reduces the likelihood of employees encountering surprise medical expenses.
• Strategic Plan Design: aequum works with employers to design health plans that minimize out-of-network risks and comply with NSA regulations. This includes integrating transparency tools that ensure employees understand the costs of their healthcare and how to avoid surprise billing scenarios.

The newly proposed NSA legislation represents an important step forward in protecting patients from surprise medical bills and holding insurers accountable. For employers, ensuring compliance with these regulations is essential to avoid penalties and protect their employees.

Addressing Challenges in the NSA

The original NSA legislation was designed to prevent surprise billing by protecting patients from out-of-network charges in emergency situations and when receiving care at in-network facilities. However, since its implementation, loopholes have allowed balance billing violations to persist, often leaving patients caught between insurance providers and healthcare facilities.

The newly proposed legislation aims to remedy these issues by increasing penalties for non-compliance and ensuring stricter enforcement of balance billing protections.

Key provisions of the bill seek to:

• Increase financial penalties for insurers and health plans that violate balance billing rules.
• Strengthen transparency requirements to ensure patients are better informed about their coverage and potential out-of-pocket costs.
• Simplify the claims resolution process between insurers and healthcare providers to prevent patients from being stuck in the middle of billing disputes.

This is a crucial step in protecting patients and improving the accountability of health plans and insurance companies. However, the complexity of healthcare laws and regulations means that employers must take proactive steps to stay compliant and protect their employees.

Value of a Medical Billing Partnership

aequum offers the comprehensive support employers need to navigate the evolving healthcare landscape, providing long-term solutions that prevent surprise billing issues and help create a more transparent, equitable healthcare system.

By partnering with aequum, employers can rest assured that their health plans are compliant with the latest legislation and their employees are protected from the financial burden of surprise medical costs.

To learn more about how aequum can help with NSA compliance and other healthcare challenges, contact us today.