Tony Mira, Anesthesia Business Consultants’ president and CEO, laid out how this act will affect anesthesia providers when the provisions take effect Jan. 1.
Three changes to know:
Independent dispute resolution
The rule creates a process for federal independent dispute resolutions that out-of-network providers can use to determine the appropriate rate for a service if negotiations are unsuccessful.
Parties select a “certified independent dispute resolution entity” and then send their offers for payment to the selected entity. The entity will then select one of the parties’ offers.
Good faith estimates for uninsured
Providers must provide a good faith estimate of expected charges for services to uninsured patients.
The good faith estimate must include expected charges that are reasonably expected with the item or service, including what may be charged by other providers.
While anesthesia providers aren’t explicitly mentioned in the rule, Mr. Mira advises to err on the side of caution by providing an estimate of anesthesia services for these patients.
Dispute resolution process
Where a no-insurance beneficiary receives a bill that is substantially above the good faith estimate, a patient-provider dispute resolution process is authorized by the rule for the purpose of determining the appropriate payment amount.
The dispute resolution process involves certain timelines for documentation submission and payment determination.
Read more here.
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