no surprises act

Health plans are facing new communication requirements with the No Surprises Act. The legislation passed will force insurers to provide cost estimates before services. These changes will likely impact the volume of patient communications you send by mail, and you’ll need a plan in place to manage it.

What Is the No Surprises Act?

The No Surprises Act, enacted as part of the Consolidated Appropriations Act, mandates that health plans send advanced EOBs (explanation of benefits) to their members. The objective is to “not surprise” patients with exorbitant costs after a treatment or procedure. It will also call for insurers to deliver price comparison guidance either online or by phone. This aspect of the law is similar to the requirements under the Transparency in Coverage regulations. It becomes effective in 2022.

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Who Is Impacted by the Law?

The legislation applies to both grandfathered and non-grandfathered plans under the Affordable Care Act. Upon notice of a scheduled service, insurers must send the advanced EOBs. The timing of when depends on when the patient plans the service or requests the estimate.

If it’s between three and nine days, a patient must receive the document within one business day after receiving the request. If the procedure is more than 10 days out, insurers must send it within three business days.

eob - explanation of benefitsWill Your Patient Communication Volume Increase?

Based on the number of members your plan has that fall under these requirements, you may be able to estimate the expected volume of print and mail to expect. Using other analytics around patient data regarding common procedures, treatments, or services may help you forecast this, as well.

If you already have challenges with your system for printed and mailed patient communication, this could be an ideal time to take stock. Take the time to understand where you can improve it, relating to costs, accuracy, compliance, and overall infrastructure.

For example, if you currently operate an in-plant for your print and mail, can it take on more capacity? How will spikes in volume impact your operations and expenses?

If you currently outsource healthcare communications, are you confident your vendor can support you? Will they be able to meet those quick timelines?

Ensure Compliance, Accuracy, and Lower Costs with the Right Partner

As a health plan, you are compliance-centric, and that’s probably your primary motivator in print and mail. Adjacent to compliance is accuracy, which means you have systems in place to assure that every patient letter gets into the correct envelope. Additionally, you want to reduce costs associated with these activities.

To achieve all three of these objectives, you need the right partner. PCI Group meets all these and more.

  • Industry leading accuracy at 99.9999% due to our advanced technologies.
  • HIPAA and HITRUST compliant.
  • Years of experience working in the healthcare
  • Reduced costs in areas of energy, postage, and compliance and the elimination of inventory costs because pre-printing isn’t necessary.

Be Prepared for the No Surprises Act

Just as patients don’t want surprises, neither do you when it comes to new compliance mandates. Be ready for 2022 by rethinking your print and mail operations with us. Contact our transactional mail experts today to learn more.