For past few years, patients have faced unexpected medical bills that cause stress and financial problems. The No Surprises Act (NSA), which started in January 2022, was created to protect patients from these surprise costs and make medical billing clearer. Now, in 2025, the law is still changing how healthcare billing works, affecting both doctors and insurance companies.
Understanding the No Surprises Act
The No Surprises Act was created to stop patients from receiving unexpected medical bills. These surprise bills often happen when patients unknowingly get care from doctors or hospitals that are not in their insurance network. This problem is especially common in emergency situations.
The law includes several important rules:
- Hospitals and doctors cannot charge higher out-of-network prices for emergency care. Even if a patient goes to an out-of-network hospital in an emergency, they will be billed as if they went to an in-network facility.
- Certain non-emergency services at in-network hospitals also cannot have extra out-of-network charges. This means that if a patient visits an in-network hospital for a planned procedure, they will not suddenly get a bill from an out-of-network doctor who helped with their care.
- Doctors and hospitals must tell patients in advance how much their care will cost for non-emergency services. This helps patients understand their medical expenses before they receive treatment.
- If there is a disagreement between an insurance company and a healthcare provider about a bill, they can use a special process to settle the dispute. This prevents patients from getting caught in the middle of billing conflicts.
How the NSA Has Affected Medical Billing Practices
1. Increased Transparency in Billing
The NSA has helped make medical bills clearer by requiring doctors and hospitals to give patients a cost estimate before a procedure or service. This estimate, called a Good Faith Estimate (GFE), helps patients know how much they might have to pay. It also helps healthcare providers keep their billing more organized and consistent.
2. Changes in Reimbursement and Payer Negotiations
When insurance companies and healthcare providers disagree on how much to pay for medical services outside the patient’s insurance network, they now use a process called Independent Dispute Resolution (IDR) to settle the issue. This process changes how insurance companies and providers negotiate payments, which can affect how much money healthcare providers earn from these services.
3. Impact on Revenue Cycle Management
Healthcare providers have had to change the way they manage their finances because of new rules they must follow. Billing departments need to make sure they follow the NSA rules, especially when giving patients cost estimates and dealing with payment disputes through the IDR process. If they do not follow these rules, they could face penalties or have their payment claims denied. That is why it is very important for them to keep accurate records of everything.
4. Reduction in Surprise Medical Bills
One of the biggest benefits of the NSA is that patients now receive less surprise medical bills. Because of the new protections, patients are less likely to get unexpected charges that they were not prepared for. This has helped many people feel less stressed about paying for healthcare. As a result, more patients are satisfied with their medical care and trust their doctors and hospitals more.
Challenges and Future Considerations
The No Surprises Act has helped patients avoid unexpected medical bills, but it has made things harder for people who handle medical billing.
- More Administrative Work: Billing teams now must do extra tasks, like creating cost estimates for patients before treatment and taking part in payment dispute processes. This means more paperwork and time spent on managing billing.
- Less Income for Some Providers: Some doctors and hospitals are making less money than before because they can no longer charge high prices for out-of-network services. This change has affected providers who depended on these higher payments.
- Keeping Up with Changing Rules: The law is still being updated, so doctors, hospitals, and billing teams must stay informed about new rules. If they do not follow the latest regulations, they could face penalties or problems with insurance payments.
Conclusion: Navigating the Future of Medical Billing
The No Surprises Act has changed how medical billing works by making costs clearer for patients and protecting them from surprise bills. At the same time, these new rules have created challenges for doctors, hospitals, and billing teams, who must adjust to new ways of handling payments and following regulations.
At Talisman Solutions, we help healthcare providers understand and follow these new billing rules. Our team specializes in creating smooth and efficient billing processes that meet all legal requirements. We stay updated on industry changes and use smart financial strategies to help providers manage their money better. By offering expert guidance, we help healthcare providers stay financially strong and compliant in an industry that is always changing.
