Claims subject to the No Surprises Act (NSA) regulations have, over the last few months, begun to move through the revenue cycle process with new coding and regulatory compliance applicable for these claims. In preparation, on March 2, 2022, CMS issued a list of NSA specific remittance advice remarks codes (RARCs), approved by the RARC Committee, that Plans and insurers may use.
The codes fall into the following categories:
- The No Surprises Act Provisions that Apply to the Claim
- How Cost Sharing Was Calculated under the NSA
- Initial Payment Amount
- Final Payment Amount
- Denial of Payment
- Notice and Consent
Since these codes are new, providers should review remittances carefully for accuracy, consistency, and applicability in general and be conscious of any discrepancies in remark codes between ERAs and EOBs. Understanding the regulatory requirements and applicable laws for each claim is becoming increasingly more complex but vital to maximize reimbursements for out-of-network providers.
The efforts by payors to minimize payments to out-of-network providers is ongoing and providers with complex surgical cases may want to consider out-sourcing these claims for handling. Cohen Howard has been servicing the out-of-network provider community for years and are well versed in NSA compliance and navigating the insurance industry. Call us today to discuss.