As seen in Modern Healthcare: It’s time to get ready for the surprise billing ban, experts say

nThrive medical billing technology preparation

Mark Janiszewski, Chief Strategy & Product Officer at nThrive, was featured in a Modern Healthcare article by Michael Brady centered around hospital and healthcare systems preparation for the surprise billing ban that will go into effect 2022.

The interim final rule that was published last month covers the basics but leaves out essential details about how the No Surprises Act will work in practice. The No Surprises Act will force hospitals to be more forthcoming with their patients about billing for emergency care and out-of-network care. Despite the uncertainty, healthcare providers need to start preparing for the new rules now—and most aren’t ready. In the article, Mark joins a handful of other industry experts, discussing the impact that a surprise billing ban will have on hospitals and healthcare systems.

“Hospitals may need to rethink their outsourcing strategy for providers and services, especially if they outsource to providers that don’t accept most insurance plans,” said Mark.

On the topic of hospitals outsourcing to providers that don’t accept many insurance policies, Mark says, “There have been some bad actors out there who sort of do this on purpose, right? They don’t accept a lot of insurance, and then they try to bill on a self-pay or full-price basis. That’s part of their financial model.”

Mark also talks about his belief that hospitals must spend more time ensuring that the providers they use are in-network for the largest insurers in their respective markets. “You could end up with individual surprise billing because a provider is new and hasn’t been enrolled in that insurance network. Hospitals should look at their internal processes to ensure that they’re referring patients to an in-network provider,” Janiszewski said. “I don’t think that’s something they’re really thinking about or checking for right now.”

In addition, providers need to determine whether the new surprise billing regulations apply to them and under what circumstances.

To learn how nThrive can help your hospital or healthcare organization prepare for the upcoming surprise billing ban, contact our revenue cycle experts.

Comments on the interim final rule closed on Sept. 7.

To read the full Modern Healthcare article, click here.


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