You’ve Never Been There and Neither Have We: A No Surprises Act Roadmap

While the verdict is still out on how the No Surprises Act (NSA) will benefit certain individual plan members and patients, the NSA has a significant impact on health plans, health systems, and medical care providers in the United States. With another NSA compliance deadline rapidly approaching on January 1, 2023, many of these payer and provider stakeholders are raising concerns about the challenges associated with regulation and the significant impact it’s having on their organizations; particularly in terms of compliance, process, operations and finances. Some organizations, including various national and state-level health plans, hospital, and medical associations, are going so far as to file lawsuits and briefs challenging various aspects of the No Surprises Act.

Partnering to Present a No Surprises Act Roadmap

Earlier this month, the HealthCare Executive Group (HCEG) and WEDI: Workgroup for Electronic Data Interchange presented a special Partner Programming session at HLTH 2022 in Las Vegas. On Wednesday, November 16th, HCEG’s Ferris Taylor joined WEDI’s President Charles Stellar and VP of Federal Affairs, Robert Tennant to present “You’ve Never Been There and Neither Have We: A No Surprises Act Roadmap.”

HCEG and WEDI are thankful to HLTH for providing the opportunity to share this information with attendees of the HLTH 2022 event in Las Vegas this month.

Price Transparency: Overall Benefit and Barriers to Required Interoperability

In this 90-minute HLTH Partner Programming session, Ferris shared findings from the 2022 Industry Pulse survey that reflected payer and provider views on the practical effects of price transparency and whether, at least at the overall national level, increasing price transparency will have a positive effect on the cost of healthcare. Also shared were viewpoints on the barriers to achieving interoperability – a foundational aspect of the No Surprises Act.

Key Compliance Stops On Your No Surprises Act Roadmap

Robert Tennant then presented detailed information on the current state of No Surprises Act Legislation and Supporting Regulations related to the price transparency landscape including details and recommendations from WEDI’s No Surprises Act Task Group on the following topics:

NSA Data Exchange Requirements
Good Faith Estimate (GFE)
Convening Provider
Advanced Explanation of Benefits (AEOB)

Arriving at a Good Destination – WEDI Recommendations to HHS

Robert shared many details about key waypoints on the roadmap to NSA compliance including key findings and recommendations from the WEDI NSA Task Group. The week before the HLTH 2022 event, WEDI sent a comment letter to HHS Secretary Becerra on the No Surprises Act. The letter outlined WEDI concerns regarding the implementation of the NSA’s data exchange provisions and offered recommendations for an industry glide path – or roadmap – to addressing the issues facing health plans, providers, and facilities.

Learning More: Session Materials and Partnering with Healthcare Innovators

With special thanks to WEDI’s Robert Tennant, a large amount of timely information on the No Surprises Act was made available during the Partner Programming Session at HLTH 2022. Access the presentation deck here and the HLTH session recording available here.

HCEG and WEDI are also especially thankful to HLTH for providing the opportunity to share this information with attendees of the HLTH 2022 event in Las Vegas this month.

Check out the following for information on other HCEG, WEDI, and HLTH events and content.