Feature March 23, 2022 John Bernot, MD

What orthopaedic surgeons need to know about surprise billing legislation

Here’s what orthopaedic surgeons need to know about the No Surprises Act to protect the financial health of your practice or surgery center.

After years of negotiations, the No Surprises Act (NSA), which provides federal consumer protections against surprise medical bills, went into effect on January 1, 2022, as part of the $1.4 trillion Consolidated Appropriations Act.1

A surprise bill occurs when an insured patient unknowingly receives out-of-network care and subsequently receives a bill for it. 

Federal action on the issue is warranted due to how widespread the problem is—a 2020 study found that one-third of insured adults ages 18-64 reported having received a surprise bill within the past two years.2

Surprise bills are associated with: 

  • 1 in 5 emergency room visits3 
  • 9-16% of in-network hospitalizations for non-emergency care3

One surprise billing scenario orthopaedic practices and surgery centers may encounter is when a patient is billed for an out-of-network anesthesiologist. The patient doesn’t select the anesthesiologist for their procedure and therefore has no way of knowing they may be out-of-network.3

This is just one example of how the NSA can impact the financial health of your orthopaedic practice or surgery center. 

Read on to learn about the American Academy of Orthopaedic Surgeons’ (AAOS) position on the NSA and how you can protect revenue.

Overview and implications for orthopaedic surgeons: AAOS position

Here’s how the No Surprises Act is set up to work: 

  • Removes patients from the middle of out-of-network billing disputes4
  • Establishes an independent dispute resolution (IDR) process that permits batching of claims4
  • Stipulates notice-and-consent requirements when out-of-network clinicians provide care at in-network facilities1

While the AAOS wholeheartedly supports the spirit of the legislation to protect patients, they do not support its implementation, raising the following concerns4

  • Overlooks congressional intent
  • Disregards the “complexity of services, market share, level of training, experience, and quality and outcome measurements”
  • Prioritizes median in-network rates established by insurers
  • Risks government price-setting

On January 7, 2022, mere days after the legislation went into effect, the AAOS signed onto an amicus brief supporting a lawsuit filed by the American Medical Association.4

Protecting the financial health of your practice or ASC

New legislation like the No Surprise Act, as well as the transition from fee-to-service to value-based care, can have significant consequences on the financial health of your practice or surgery center.

While you may not have control over the legislative process, you can be proactive about finding ways to increase practice revenue with the right digital health tool. 

Ayva, a dynamic patient engagement platform, enables you to prioritize patient activation and engagement for improved financial and patient outcomes.

Meet Ayva!

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Shane Andreasen

Bravado Health

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Bravado Health Media Line

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