How the No Surprises Act Affects your Mental Health Agency

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The No Surprises Act, passed in 2022, was designed to protect consumers from unexpectedly high healthcare costs. Before the Act’s implementation, it was common for patients to be billed for non-covered costs during emergencies or when patients hadn’t approved out-of-network charges in advance.

Consider, for example, a woman who may have been struggling with anxiety and depression. After several sessions with a therapist, she began to feel much better, but the bill she later received may have been much higher than she expected due to extra services the therapist provided her. These unanticipated expenses might have caused severe financial stress and anxiety for the woman, undoing the progress she had made in her therapy sessions.

As a result of the No Surprises Act, mental health consumers like this who choose to self-pay are afforded straightforward cost estimates in advance of treatments, and all patients are spared from getting caught in the crossfire of cost disputes between providers and insurers.

Behavioral health agencies must know that the No Surprises Act applies to all providers, including therapists. Thanks to the No Surprises Act, behavioral health providers across the country must comply with transparent billing and other provisions as of January 1, 2022.

Your behavioral health company is ready to implement a white label telehealth and patient portal. So, what comes next?

Clinicians and agencies, including behavioral health agencies, who are out of compliance with the No Surprises Act can face serious consequences. The Act imposes penalties of up to $10,000 per violation for providers who fail to comply with its requirements. Additionally, providers may be subject to legal action from patients who receive unexpected medical bills or have disputes over charges.

According to the No Surprises Act, behavioral health providers must:

Provide up-front estimates of costs (known as “Good Faith Estimates”) to uninsured patients, self-pay patients, and out-of-network patients receiving care at an in-network facility;
Establish a mechanism (a “Patient-Provider Dispute Resolution” process) to dispute charges that are significantly in excess (>$400) of the good faith estimate provided; and
Refrain from “balance billing” to compensate for uncovered costs when patients receive emergency care from out-of-network providers.

Your behavioral health company is ready to implement a white label telehealth and patient portal. So, what comes next?

Complying with the No Surprises Act means behavioral health agencies must prioritize collecting and maintaining the information they need for accurate billing and estimates. Information like in-network status, services rendered, and expected costs must be readily available and communicated to patients clearly and transparently.

The No Surprises Act states that every Good Faith Estimate must include the following:

  • A clear description of services that will be provided,
  • Itemization of every component of the services that will be billed (i.e., number and frequency of scheduled sessions), and
  • Each item’s expected cost and associated procedure code.

Behavioral health agencies may find it difficult to fully comply with this provision of the No Surprises Act without the aid of technology (or the recruitment of additional full-time administrative staff). Integrated patient access solutions – such as those that offer deep integration between patient portals and EHR – can seamlessly facilitate the exchange of insurance information and up-to-date treatment information so that companies can consistently provide accurate Good Faith Estimates.

System integration can also help behavioral health agencies better understand the needs of patients, the types of services they are engaging with, and therefore the costs associated with care. And when an integrated patient portal/EHR enables patients to self-schedule and self-admit to services, agencies can effortlessly capture vital details related to healthcare costs.

The No Surprises Act is critical legislation that shields patients from unexpected medical bills. Any law that prevents anxiety-causing unanticipated medical expenses should be embraced by mental health providers. Utilizing innovative technology solutions like integrated EHR systems and patient portal software allows mental health providers to simplify compliance with the Act while continuing to deliver excellent, compassionate care to their patients.

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