Implications of the No Surprises Act on Telehealth

The No Surprises Act is not new, there has been a lot of conversations about the Act and it was signed into law as part of the Consolidated Appropriations Act of 2021 all the way back in December of 2020. However, the No Surprises Act did not officially go into effect until January 1st of 2022. This blog will cover the basics of what the No Surprises Act entails and how it can impact telehealth providers.

A summary of the main provisions is as follows according to the American Hospital Association:

1. Protects patients from receiving surprise medical bills for emergency services (and select other services) by out-of-network clinicians at a facility that is in-network.

2. The patient is only liable to pay what is allowable by their in-network cost-sharing amount. 

3. Allows providers and insurers to access an independent dispute resolution process in the event disputes arise around reimbursement. 

4. Requires both providers and health plans to assist patients in accessing health care cost information. 

If you are a healthcare provider or are interested in more details about the No Surprises Act you can find a detailed summary from the American Hospital Association here. 

Implementation Challenges for Healthcare Organizations

Information in this section of the blog comes from the Healthcare Finance Article here and Foley and Lardner.  

Many healthcare organizations are still grappling with what defines emergency services or when emergency services have been completed and patient consent can be tricky during emergency situations. But another area that still is not well understood is its impact on telehealth consults in the ER. 

Impact on Telehealth

As the Director of the UMTRC and the Crossroads Partnership for Telehealth. I have seen several healthcare organizations utilize telehealth in their emergency services through a variety of specialties. Two specialties the Crossroads Partnership for Telehealth has focused on are tele-behavioral health services and tele-stroke services which are both services that are delivered through a hub and spoke model through our rural hospital's emergency departments. These specialties offered through telehealth help to cover gaps that rural facilities can face when it comes to specialized care such as behavioral health and neurology.

As mentioned by Kyle Faget from Foley and Lardner we see that many of these telehealth providers can work on a contracted basis. They are credentialed at the hospital but are not directly hospital employees which can mean they may not be credentialed with the insurer. Under the No Surprise Act, these providers are now subject to the in-network rates negotiated by the hospital. Due to these contract ER physicians being a smaller group they may have difficulty negotiating higher rates for their in-network services. 

 "It's an arduous contracting process, and small-group bargaining power is low," Faget said. "The big hospital system has bargaining power. Those groups providing telehealth services won't necessarily have agreements in place and, by definition, are out-of-network." Independent physician groups, which include telehealth docs, must now accept a rate that someone else has negotiated, Faget said. This fact can be more of an issue than the lower rate they're now being paid, she said". The UMTRC will continue to monitor this issue as time progresses, if you have any questions please feel free to reach out to us.