No Surprises Act 4 years later: What’s the status of healthcare transparency?

At this point, many members of the healthcare industry, including patients, have heard of the No Surprises Act (NSA). The NSA was signed into law in December 2020, effective January 2022, and designed to protect patients from costly, unexpected medical bills that can occur, sometimes because a procedure or service is out-of-network with a patient’s health plan. To avoid this, the law requires providers to give patients Good Faith Estimates (GFEs) of the expected cost before care is rendered.  

Additionally, the Lower Cost, More Transparency Act was passed by the US House of Representatives. While this act still must pass through the Senate and President, it represents a deeper need for healthcare price transparency. This act aims to make healthcare costs more accessible for Americans while supporting healthcare organizations in doing so.  

Looking back on the past 4 years since the NSA was passed, there are many questions surrounding the effectiveness of the legislation:  

• Have healthcare organizations complied?  

• How have patients benefited?  

• Why is healthcare transparency such a long process?

Compliance: A Work in Progress

Complying with the NSA has been a challenge for healthcare organizations for many reasons. Shortly after the law was enacted in January 2022, the implementation was described as “daunting” by providers. There has been pushback about the requirement of GFEs, as providers only have 1-3 days after care is scheduled to generate an estimate for patients.

Despite this, a study conducted by BCBSA and AHIP reported that over 10 million surprise bills were prevented in the first 9 months of 2023, meaning that many healthcare organizations and providers are complying in some capacity.  

While the NSA provides strict guidelines for providers, CMS has taken a supportive role in helping healthcare organizations comply with the legislation, hoping to further overall compliance.  

Patients Taking Control of Their Care

The U.S. healthcare system is opaque and complex, making it difficult for patients to understand the bills they receive. From the frustration of not knowing stemmed a greater call to action to healthcare providers, health plans, and the U.S. government. Since the NSA has been enacted, patient advocacy groups and technology companies have dove into this space, creating tools specifically for patients to know what they will owe.

PatientRightsAdvocate.org is “focused on ushering in systemwide healthcare transparency” through media and campaign outreach. Additionally, companies have created databases that let patients search for their care and get a picture of what it will cost them. More companies are cropping up in this space to provide patients with clarity as the legislation takes time to get up to speed.  

Healthcare Transparency Requires Patience (and Patients)

There are many factors as to why healthcare transparency is not an easy feat. As- previously mentioned, the U.S. healthcare system is intricate and tangled, making it difficult to impose a “one-size-fits-all” approach.  

Additionally, healthcare has heaps of data which oftentimes is messy and inconsistent, as well as hard to access. While over 90% of hospitals have posted machine readable files (MRFs) of their negotiated rates, the quality of this data and the ease of access have been criticized.

The call for price transparency from patients is still prevalent despite the implementation barriers.  

The Answer? Technology

At careviso, we are champions of healthcare transparency and have built our technology platform, seeQer, with the NSA in mind. While we are advocates of the legislation, we understand the massive burden it places on healthcare providers.

Our platform is designed for everyone involved in healthcare and generates real-time cost estimates for healthcare providers, resulting in reduced administrative burden, compliance with the law, and better patient experiences.

We are optimistic about the future of healthcare transparency and are proud to be contributors towards a clearer, simplified system for all. Learn more here.