A key subset of the No Surprises Act aims to protect patients against balance billing—when a healthcare provider sends a patient a “surprise” medical bill for the remaining cost of services after receiving reimbursement from the health plan. As of February, the Centers for Medicare & Medicaid Services is cracking down on balance billing and providers need to be prepared.

But without reliable provider data, it’s difficult to determine if providers are in-network or out-of-network with a plan, further complicating the billing and reimbursement process. Watch the latest installment of the Madaket Minute to learn more about balance billing.

Read the video transcript below and subscribe to Madaket Health on YouTube.

Video Transcript:

Hi everyone, Martin Cody here with another installment of the Madaket Minute. In this Madaket Minute I want to talk about balance billing, a subset of the No Surprises Act that really impacts us all.

Now what is balance billing? Let’s say you went to a provider or dermatologist and the fee for that visit was $300. The dermatologist would submit that to the insurance company, and let’s say the insurance company only reimburses the provider $200—or actually more realistic, $100—the provider would then balance bill you the remaining $200. In this instance that is no longer allowed, and as of this past February CMS is starting to take action on the complaints that are being logged on the CMS website—balance billing complaints.

So now if you’re a provider this is something that has to scare you because you need to be able to debate, agree to, work with insurance companies on these reimbursements, and you better have accurate data on whether or not you’re in network or out of network. And payers—their data is no more reliable than yours oftentimes.

We have to get the provider data under control and it’s what we do at Madaket. Thank you.

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