The No Surprises Act (NSA), which took effect on January 1, 2022, marked a major shift in patient protections by aiming to eliminate unexpected medical bills, especially those arising in emergencies or from out-of-network providers without patient consent. While the law is a win for patients, it has created operational and compliance challenges for healthcare providers.
Healthcare organizations are now required to provide Good Faith Estimates (GFEs), deliver advance notifications, and ensure cross-department coordination to remain compliant. Failure to comply can result in civil monetary penalties, negative patient experiences, and reputational harm.
As consultants, Healthrise helps organizations not only meet these regulatory requirements but also use this opportunity to improve overall patient access and revenue cycle performance.
Where Are Providers Struggling?
For many healthcare systems, compliance is less about intent and more about complexity. Disconnected workflows, limited EMR functionality, and inconsistencies between departments can lead to delays, inaccuracies, or gaps in patient communications.Key pain points include:
- Inaccurate or untimely patient estimates
- Lack of automated consent triggers in the EMR when providers are out-of-network
- Unclear or non-standardized procedures across Patient Access teams
- Limited visibility into compliance metrics across departments
How We Help: Strengthening Patient Access with Proven Strategies
At Healthrise, we approach the No Surprises Act as both a compliance requirement and a catalyst for patient-centered process improvement. Here’s how we support our partners:
Patient Access Workflow Assessments
We perform detailed assessments of current-state workflows and EMR configurations to uncover compliance gaps:
- Are estimates being generated accurately and delivered in a timely manner?
- Does the EMR flag out-of-network providers and trigger appropriate consent documentation?
- Are reimbursement expectations properly aligned with payor contracts within the system?
When gaps are identified, we collaborate with key stakeholders, including Payor Relations, to implement solutions that align system logic with real-world reimbursement structures.
Standardizing Front-Line Operations
We help develop Standard Operating Procedures (SOPs) to ensure Patient Access teams follow consistent, compliant workflows. This reduces variability, enhances training effectiveness, and boosts audit readiness.
Cross-Departmental Alignment
True compliance requires alignment across the revenue cycle. We work with:
- Patient Financial Services
- Revenue Integrity
- Coding
- Clinical Operationsto ensure all departments are aware of their responsibilities and integrated into a unified compliance framework.
Risk Mitigation and Monitoring
We design reporting dashboards and KPI tracking tools that give leadership visibility into:
- Estimate accuracy and timeliness
- Consent documentation rates
- Department-level compliance performance
This enables real-time monitoring and early identification of risks which are essential for audit preparedness and operational confidence.
Enhancing the Patient Experience
Ultimately, the No Surprises Act is about building trust with patients. We support initiatives that:
- Improve price transparency
- Increase estimate accuracy
- Provide early notice of noncovered services
These improvements not only meet compliance standards, they elevate the patient experience and strengthen long-term relationships.
Conclusion
The No Surprises Act is reshaping patient access expectations, and healthcare organizations must rise to meet them. With the right consulting partner, compliance can go beyond risk avoidance and become a strategic advantage.Healthrise brings the experience, tools, and collaborative approach needed to help providers navigate change, align teams, and build a patient-first access strategy that lasts.
Ready to take your Patient Access to the next level? Discover how Healthrise can help your organization thrive.
Contact Us
