Here’s why you should pay attention:
1. The Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act requires healthcare facilities and providers to notify patients if they are out-of-network before scheduling a non-emergency appointment — which would apply to appointments at ASCs.
2. In non-emergency cases, the law also requires providers to disclose projected service costs upon request and inform patients of their financial responsibility pertaining to out-of-network services. Physicians must give patients a chance to check whether any other provider scheduled for the procedure is in-network.
3. The law outlines arbitration procedures pertaining to cases when an out-of-network facility and insurance carrier can’t agree on reimbursement.
4. New Mexico, Washington and Virginia are reviewing the problem of balance billing, and Oregon and New Hampshire have signed related measures into law.
5. InsideARM predicts similar laws will begin popping up across the country, and they may look to New Jersey for guidance. ASCs should refer to any available guidance for compliance regarding non-emergency cases.
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At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.