WMC implements new processes in compliance with No Surprises Act

WORLAND – The Washakie Medical Center Hospital Board, at its Jan. 25 meeting, received a report that Banner Health’s Patient Access Services implementation of new processes to be compliant with the federal government’s No Surprises Act was underway.The No Surprises Act went into effect Jan. 1 and establishes federal standards designed to protect patients from balance billing for defined items and services provided by specific doctors, hospitals and air ambulance carriers on an out-of-network or self-pay basis.

According to the Centers for Medicare and Medicaid Services website, “consumers have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Through new rules aimed to protect consumers, excessive out-of-pocket costs are restricted, and emergency services must continue to be covered without any prior authorization, and regardless of whether or not a provider or facility is in-network.

“Previously, if consumers had health coverage and got care from an out-of-network provider, their health plan usually wouldn’t cover the entire out-of-network cost. This left many with higher costs than if they’d been seen by an in-network provider. This is especially common in an emergency situation, where consumers might not be able to choose the provider. Even if a consumer goes to an in-network hospital, they might get care from out-of-network providers at that facility.

“In many cases, the out-of-network provider could bill consumers for the difference between the charges the provider billed, and the amount paid by the consumer’s health plan. This is known as balance billing. An unexpected balance bill is called a surprise bill.”

According to the CMS, the act protects people from surprise medical bills and removes consumers from payment disputes between a provider or health care facility and their health plan.

According to Board Chairman Dean Carrell, while many of the rules apply to emergent situations under the Price Transparency Act, Banner Health now posts the balance billing rules and forms on their public website. They also now provide a timely notification in clear and understandable language of the good faith estimate that includes the expected charges for providing items and services to the patient or payer, Carrell said.

Finally, they will offer price-comparison guidance by telephone or make-available on their website a price-comparison tool that allows individuals to compare the cost-sharing for items and services received by the participating provider and geographic region, he added.

In other business, according to Carrell, the Washakie Medical Center hospital board welcomed new hires in environmental services, clinical support analyst and provider education and nursing during the monthly meeting on Jan. 25.

Washakie Medical Center CEO Jay Stallings reported that despite the flu going around as well as the omicron COVID variant, they are not seeing any spike in absences.

“We continue to be highly focused of the message ‘if you feel sick, stay home,’” Stallings said. “We check in every morning with all of our leaders in a daily huddle to ensure we have the resources to do our work serving our community.”

He added, “In general, I believe our policy of vaccinating for flu and COVID, as well as strict adherence to masking, hand-washing and social distancing, shows the benefit in keeping our team safe.”