The Impact of the No Surprises Act on Surgeons

The No Surprises Act (NSA) was enacted as part of a broader effort to protect consumers from unexpected medical bills, particularly from out-of-network services. While the primary goal of the NSA is to eliminate the financial shock associated with these bills, the legislation was interpreted by regulators in unintended ways, with devastating effects on the medical industry, especially surgeons.

One of the most significant impacts of the NSA on surgeons has been the reduction in reimbursement rates.

Previously, surgeons could charge higher rates for out-of-network services, which often compensated for the complex and unpredictable nature of their work, especially when the treatment was emergent. However, under the NSA, the reimbursement rates for out-of-network services are now set, in the first instance, based on the median in-network rate, which is typically much lower. The surgeon can challenge these low payments but only through an arbitration process, established by the legislation. If this option is not pursued, the surgeon is left with the drastic underpayment as full reimbursement.

Register for: Unified Health Webinar July 11 @ 6pm

As a result, many surgeons have experienced a substantial decrease in income due to the NSA.

Surgeons in highly specialized fields, such as orthopedic surgery, neurosurgery and cardiac surgery, who previously relied on higher out-of-network reimbursements from the procedures they performed through the ER have been disproportionately affected.

In addition to reduced reimbursements, surgeons face increased overhead costs due to the NSA. The administrative burden of compliance with the new rules and regulations around disclosing to patients very specific details as to the financial possibilities of seeing an out-of-network surgeon has required many surgical practices to invest in additional staffing and billing systems. These overhead expenses diminish the overall profitability of surgical practices.

The need for upgraded billing systems and training for staff to handle these new processes has further increased the financial strain on surgical practices.

The Callagy revenue recovery team stands out as a prime candidate for addressing the many nuanced issues faced by Surgeons. Recognized by the Centers for Medicare & Medicaid Services (CMS) as a leading force in the IDR arena, the Callagy team has consistently been ranked among the top 10 IDR filers nationwide.

This distinction is not merely a testament to the Callagy team’s expertise but also reflects its commitment to advocating effectively on behalf of healthcare professionals. By choosing Callagy Revenue Recovery, you gain a partner who has recovered over $700,000,000 for their medical clients, a proven track record of navigating recovery processes, including the Independent Dispute Resolution (IDR), successfully, ensuring that your claims are handled expertly and your reimbursements are maximized. In an environment where insurance complexities can significantly impede your practice’s revenue stream, having Callagy by your side means having a formidable ally in securing the compensation you rightfully deserve.

Register for: Unified Health Webinar July 11 @ 6pm

The No Surprises Act, initially designed to shield consumers from unforeseen medical costs, has inadvertently imposed financial challenges on surgeons by lowering their reimbursement rates and escalating their overhead expenses. The Act’s framework, which aligns out-of-network payments with median in-network rates, has particularly disadvantaged specialty surgeons. Additionally, the increased administrative demands have necessitated investments in more robust billing systems and staff training, further straining the financial health of surgical practices.

Looking ahead, it is crucial for the surgical community to adapt to these regulatory changes. Collaborative efforts with entities like Callagy Recovery can provide critical support in navigating the intricacies of the IDR process and optimizing reimbursement strategies. Moreover, continued advocacy for legislative adjustments that recognize the unique financial burdens of specialized surgical practices will be essential. As the healthcare landscape evolves, the ability of surgeons to adapt to these economic and regulatory shifts will play a pivotal role in maintaining the viability of their practices and the quality of care they provide.

To learn more: Register for the upcoming webinar or reach out directly to Bart Rademaker

Unified Health Webinar July 11 @ 6pm

Dr Bart Rademaker.