The No Surprises Act went into effect in January 2022 with enforcement of the act beginning in January 2023. The No Surprises Act applies when the specimen originates from a hospital, hospital outpatient department, ambulatory surgery center, or rural critical access hospital. This can be for emergency or non-emergency services, and only when the laboratory is out of network but the originating facility is in-network. The No Surprises Act only applies to covered services, or those services that would be covered under the individuals’ health plan and does not apply to those services which the individual’s health plan deems as non-covered.
TELCOR RCM facilitates laboratories staying compliant with the No Surprises Act by providing a patient estimator tool within the TELCOR RCM application and through the RCM Portal. Additionally, balance bill statements can be controlled through Remittance Advice Instructions specific to No Surprises Act related advice and remark codes, as well as Statement Hold rules and view options within the Unbilled Patient Charges workqueue.
For co-providers or co-facilities, the Good Faith Estimate (GFE) portion of the No Surprises Act will not be enforced as of January 1, 2023 and will be delayed until the federal government develops standards and technology around creation of the GFE. There is no mention of delay in enforcement of the GFE requirement for self-pay or uninsured patients in scenarios where the lab is not in a co-provider situation.
To discuss these topics further, please contact RCM Service at rcmservice@telcor.com or 855-489-1207.