No Surprises Act Summary

No Surprises Act Summary

By Aaron Morein

Surprise! In 2020, congress passed the No Surprises Act, which protects patients from unexpected medical bills. Those rules which have been finalized were implemented January 1st, 2022. Providers will need to stay abreast of new rules and modifications coming out later this year. 


Why was the No Surprises Act Passed?

Patients often have trouble understanding their insurance benefits or knowing how much care will cost. In addition, out-of-network providers can operate within in-network facilities. Thus, patients can reasonably use out-of-network services inadvertently and receive a surprise “balance bill”: charges to cover the difference between an out-of-network provider’s billed charge and the amount the health plan paid. Prior to No Surprises, only select states and Medicare and Medicaid had protections for patients against surprise medical bills.

No Surprises Act Summary

No Surprises expands restrictions on out-of-network charges for patients with health insurance. If a health plan holder

  1. receives emergency services from an out-of-network provider,
  2. receives nonemergency services provided by out-of-network providers at in-network facilities, or
  3. requires air ambulance emergency services,

The health plan provider cannot charge more than that service’s median in-network rate.

It further stipulates that patients are entitled to a good-faith estimate of cost of care up front for most healthcare services. Healthcare facilities must provide an easy-to-understand notice of these new protections and a contact whom they may reach out to if they feel these protections have been violated. 

Additionally, this bill provides dispute-resolution opportunities for 

  • Payment disputes between insurers and healthcare providers 
  • Uninsured and self-pay individuals who receive a medical bill substantially higher than the good faith estimate they get from the provider. 
    • For services provided in 2022, patients may file a dispute claim within 120 days of the date of a bill that is at least $400 greater than the good faith estimate. 

How Providers Can Comply

The basic steps you need to take are given here. For more complete descriptions, please access the links below. 

Display a notice of surprise billing protections on your website and in your office. The easiest way to do this is to edit the model notice offered by HHS.

In some circumstances, providers must also display information about the right to receive a good faith estimate. CMS has these requirements posted here 

Ask patients if they have insurance and if they intend to submit claims or to opt-out of their benefits. If they do not have in-network benefits or want to opt-out of them, inform them of their right to a good faith estimate and dispute resolution.

Supply an estimate of the cost of care before providing services. Timeframe requirements are as follows:

  • No later than one business day if the appointment is scheduled more than three days in advance
  • No later than three business days if the appointment is scheduled more than ten days in advance or an estimate is requested without scheduling an appointment.

A good faith estimate may include services for up to 12 months, including an estimated number of services needed during that period. 

Detailed information for good faith estimate requirements are available on the APA services website.

Other new requirements are detailed by the CMS here

New rules are continuing to be updated, so check for announcements here.


Electronic Health Record Implementation Top Challenges and Barriers to Adoption and Use

Electronic Health Record Implementation: Top Challenges and Barriers to Adoption and Use.

Nearly two decades after the emergence of EHRs, the healthcare landscape is seeing more modernization efforts and a noticeable shift towards the adoption of Electronic Health Records (EHRs). Despite this substantial progress in implementing new technology in healthcare, the benefits realized in reality lag behind expectations as EHR software adoption and implementation challenges persist. So, What was a primary barrier to the adoption and implementation of EHRs?

EHR Software Implementation- at What Cost? 

Costs of implementing EHR systems are reportedly one of the top barriers to EHR adoption especially for small to medium-sized practices with no large IT budget. Several studies estimate that the initial costs of purchasing and installing an EHR system range from $15,000 to $70,000 per provider. Additionally, adopting an EHR system in your practice is not a one-time investment.  There are different associated costs  – upfront and regular- that are necessary to reap EHR  benefits including, EHR hardware and software installation, implementation assistance, staff training, and ongoing network fees and maintenance. Having a strategic plan ahead with all these potential fees mapped out is a must for successful EHR implementation and maintenance. 

Lack of Interoperability

The Office of the National Coordinator for Information Technology (ONC) estimates that between 90% and 95% of hospitals and clinical offices have adopted an EHR system. Despite that, data silos remain a significant issue hindering Interoperability (the meaningful exchange and use of clinical data across health organizations electronically through interconnected Health Information Networks (HINs) to improve care coordination). 

 In fact,  results of the 2006 survey and roundtable discussions conducted by the Healthcare Financial Management Association (HFMA) assigned  lack of interoperability a percentage of 50% in terms of the significance of this barrier to EHR use. The existence of a myriad of active, government-certified EHRs, all with different clinical terminologies, technical specifications, and functional customizations contributes to the lack of consistent standards and code sets. Thus, having one standard interoperability format across the healthcare continuum remains one of the most problematic issues with EHRs.

Finding a provider with the most interoperable system however can transform your entire practice. Using its experience of having fully integrated with The New Jersey Substance Abuse Monitoring System (NJSAMS), Zoobook Systems can integrate with state databases or health information hubs to help clinical facilities’ processes run more efficiently.

Additionally, having voluntarily obtained the 2015 ONC-ACB certification from Drummond Labs, Zoobook offers the most interoperability while scoring high on  useability, security, and compliance.


Privacy and Security Concerns 

Whereas increased interoperability and easy flow of electronic patient records across the health spectrum has brought about improved patient care and engagement for many practices, adopting an EHR system comes with a myriad of new responsibilities of safeguarding patient information and upholding patients’ trust. In the context of behavioral health, for example, patients’ mental health information is of very sensitive nature and can be potentially damaging in case of any leakage or unauthorized access.


The reality is,  all electronic systems remain vulnerable to many security threats such as encryption blind spots, malware, phishing, cyber-attacks, etc. Thus, privacy and security issues of patients’ data constitute a major concern for clinicians and patients alike. However, as technology further develops,  health organizations continue to use that to their advantage and strive to meet HIPAA Privacy Rule and Security Rule requirements to protect their user’s data.

To that end, Zoobook Systems takes protecting patients’ data as a serious responsibility. Utilizing a secure data center and network architecture (Amazon AWS servers),  Zoobook is committed to protecting your privacy and  keeping your data safe, secure and compliant.


Zoobook’s 2015 ONC-ACB certification also implies better security for its customers including:

  • End-User Device Encryption
  • Trusted Connection
  • Integrity
  • Authentication, Access Control, Authorization
  • Auditable Events and Tamper-Resistance


Workflow Disruption

From data migration, choosing suitable EHR products and features, to staff training, transitioning from paper-based records to EHR or from one EHR system to another, it becomes clear that EHR implementation processes can be highly disruptive and tedious. The process of data migration, for example, requires moving large batches of data from paper charts or from an older EHR. Not only can this be time-consuming, but it also entails decreased patient admission and less efficient staff performance during the first phase of implementation. This can inevitably lead to losses in clinical productivity and affect revenue rates.

Lack of well-trained clinicians and staff that can lead this process is another issue that adds up to this.  Naturally, with a new EHR, comes a lot to learn and workflows and office protocols to adjust to. Thus, training of staff and all end users must be mandatory for a successful and smooth transition. This transition/learning period might result in a  temporary disruption of workflow for both clinical and administrative staff and possible consequent costs. However, having a good grasp of data migration processes, prioritizing training, and devoting significant staff time to the process can all be critical  determinants of the success of EHR implementation.

Above all, choosing the right vendor partner is crucial to minimize workflow disruptions while adopting or transitioning to a new EHR system. Built for clinicians and administrators by clinicians and administrators, Zoobook will work alongside you to ensure your system is built to your specifications, prepare you for a smooth system go-live and continue to provide support in every step of the way beyond go-live. 

Staff Resistance and De-motivation to Use EHRs

As with any process shift,  many staffs’ initial reaction to a new technology-based system is denial, demotivation and resistance  to change as one study suggests. 

Wondering what can be done to overcome resistance within your organization during EHR implementation ?

The Office of the National Coordinator for Information Technology suggests the following measures to create a more receptive culture to EHR implementation:

  1. Identify the source of resistance to address  staff members  fears and misconceptions about EHRs and emphasizing EHR benefits.
  2. Involve all staff members in making decisions to reinforce the importance of participation of all end users in the EHR implementation process. 
  3. Reinforce the value of every member involved and provide support to those showing resistance.
  4. Address negative behaviors and to objectively negotiate your way  towards mutual understanding and gain.
  5. Listen Schedule regular power meetings to engage everyone in the organization and hear everyone’s opinion. 


The Bottom Line

As with any other process, EHR implementation is not a one-time episode, but rather an ongoing and multi-dimensional enterprise. Challenges facing EHR adoption  are not limited to the initial implementation phase but  can persist long after. Therefore, to realize the full potential of an EHR system, its adoption must be part of a well-designed plan that takes the above mentioned challenges into perspective and continuously works to monitor EHR functionality. This can be done  by  choosing a strong health IT vendor partner to assist your practice throughout the process and connect your efforts with positive outcomes.