Healthcare Strategic Growth Blog

What Healthcare Providers Can Expect

By Morgan Atkins
Vice President, Product and Innovation

Be Equipped to Address the Fallout of this Legislation 

By Stephen Burgess, Ancore Health, and Michael Shipley, Stratasan

On July 1, 2021, the Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management issued an interim final rule to implement fundamental parts of the No Surprises Act (NSA). Despite the disarming title, the No Surprises Act will lead to many surprises, around lack of parity in reimbursements within a market. In upcoming years, payers and providers will be forced to evaluate their value proposition, market positioning, customer/patient transparency, and data analytics.

The NSA contains key protections to hold consumers harmless from the cost of unanticipated out-of-network medical bills. According to the Kaiser Family Foundation, “surprise bills lead the list of affordability concerns for many families; 2 in 3 adults say they worry about unexpected medical bills, more than the number worried about affording other health care or household expenses.  Surprise bills can number in the millions each year.”

While the major implications of the NSA will benefit consumers, the severity of impact that this legislation will have on payers and providers will depend on how they react. In this post, we’ve worked to summarize this new law and discuss some of the ways that both providers and payers can be prepared to act.

When entering payer/provider reimbursement negotiations, the need for data to back your position is critical. The right insights can show how your payer contracts compare to the market, how payer rates have changed over time from facility to facility, and highlight financial opportunity. This intelligence can equip you to more successfully navigate payer negotiations and leave with more favorable reimbursement rates.

The infographic below highlights a particularly helpful data-based insight called Fair Market Reimbursement. This is a reasonable range of reimbursement rates that all providers within a local market receive from a commercial insurer or payer. Created by our partner Ancore Health, the infographic below explains Fair Market Reimbursement in more detail, by answering several common questions.