Impact of the No Surprises Act on Network Participation and Payment Trends
The No Surprises Act, effective from January 1, 2022, targets the elimination of unexpected billing for patients undergoing treatment from out-of-network providers during emergencies. A comprehensive report by the U.S. Government Accountability Office (GAO) examines its influence on network participation and payment trends, with a focus on emergency medicine, radiology, anesthesiology, and air ambulance services. These insights are pivotal for stakeholders in the insurance industry aiming to meet regulatory compliance requirements effectively.
Changes in Network Participation
The GAO report highlights a considerable shift in network participation after the act's enforcement. From 2019 to 2021, there was a decline in in-network claims for emergency medicine. However, post-No Surprises Act, there has been a notable increase, indicating heightened provider participation in health plans. This trend is evident across three of the four specialties reviewed, showcasing a broader inclination of healthcare providers to align with health insurance networks.
Payment Trends for Emergency Services
The study also scrutinized payment adjustments for emergency services pre-and post-legislation. Inflation-adjusted payments for facility-billed in-network emergency services have been rising steadily from 2019 to 2023, adhering to existing trends. In contrast, payments to physicians for similar services have dwindled during the same timeframe, following earlier tendencies.
Underlying Mechanisms
Network agreements crucially involve the negotiation of payment rates between health plans and providers, defining full service payments, including insurance and patient cost-sharing. The legislation's restriction on balance billing—where out-of-network providers charge patients beyond pre-determined rates—has been instrumental in alleviating the financial strain of surprise medical bills.
GAO's Methodology and Insights
To thoroughly analyze these evolutions, the GAO reviewed extensive claims data from 2019 to 2023, including inputs from 20 stakeholder groups like specialty provider associations, insurance issuers, and state insurance departments. The report reflects the changing dynamics of network participation and payment practices post the implementation of the No Surprises Act.
For more detailed analysis, the GAO report offers extensive insights and can be contacted through John E. Dicken at dickenj@gao.gov. The Department of Health and Human Services and the Department of Labor contributed additional technical insights, reinforcing the report's conclusions. Staying informed about these shifts is crucial for insurance industry stakeholders to adeptly manage the changes induced by new regulatory frameworks.