As a healthcare provider in Virginia, you are responsible for providing quality care to your patients while also ensuring that your practice remains financially viable. However, in recent years, the issue of balance billing has become a major concern for both patients and providers. In response to this issue, the Virginia state government has introduced balance billing protection laws to safeguard patients from unexpected medical bills. To understand balance billing protection in Virginia, we will discuss what balance billing is, why it’s a problem, and how the balance billing protection law in Virginia can help you navigate this issue.
What is Balance Billing?
Balance billing occurs when a healthcare provider bills a patient for the difference between the amount charged for a medical service and the amount paid by the patient’s insurance company. This practice can occur when a patient seeks care from an out-of-network provider, or when a provider’s charges exceed the allowable amount determined by the patient’s insurance plan. When a patient receives an unexpected balance bill, it can lead to financial strain and create a negative experience for the patient.
Why is Balance Billing a Problem?
Balance billing is a problem because it can create unexpected financial burdens for patients, which can negatively impact their ability to pay for other essential expenses, such as housing or food. Patients may also feel frustrated or confused by the billing process, which can harm the provider-patient relationship. Additionally, patients may choose to forego necessary medical care if they fear receiving a balance bill, which can lead to untreated medical conditions and more severe health issues.
How does the Balance Billing Protection Law in Virginia Help?
The balance billing protection law in Virginia provides several key protections for patients to help prevent unexpected balance bills. Under this law, patients are protected from balance billing in certain situations, including:
- Emergency care: Patients cannot be balance billed for emergency care, regardless of whether the provider is in-network or out-of-network.
- Involuntary out-of-network care: If a patient receives care from an out-of-network provider at an in-network facility without their consent, the patient cannot be balance billed.
- Voluntary out-of-network care: If a patient chooses to receive care from an out-of-network provider, the provider must inform the patient in advance of any potential balance billing and provide an estimated cost of the service.
- Surprise medical bills: Providers must notify patients in advance of any potential balance billing and provide an estimated cost of the service, including any applicable deductibles or coinsurance.
If a patient receives a balance bill in violation of the balance billing protection law, they can file a complaint with the Virginia State Corporation Commission (SCC). The SCC will investigate the complaint and may impose penalties on the provider if they are found to be in violation of the law.
What can Healthcare Providers do to Comply with the Law?
As a healthcare provider, it is essential to understand and comply with the balance billing protection law in Virginia. Here are some steps you can take to ensure compliance:
- Educate your staff on the balance billing protection law and its requirements.
- Verify patient insurance coverage and inform patients in advance of any potential out-of-pocket expenses.
- Inform patients in advance of any potential balance billing and provide an estimated cost of the service, including any applicable deductibles or coinsurance.
- Participate in insurance networks to help ensure that your charges are within the allowable amount determined by insurance plans.
- Ensure that your billing and coding practices are accurate to prevent unintentional balance billing.
The balance billing protection law in Virginia provides essential protections for patients to help prevent unexpected medical bills. As a healthcare provider, it is your responsibility to understand and comply with this law to help ensure a positive experience for your patients. By following best practices and complying with the law, you can help prevent balance billing and provide quality care to your patients while also protecting the financial viability of your practice. Additionally, complying with the balance billing protection law can help foster a positive relationship between providers and patients, which is essential for long-term success.
About Medisys Data Solutions (MDS)
We hope this article might has given you better understanding of balance billing protection in Virginia. Medisys Data Solutions (MDS) understands the complexities of medical billing and the importance of complying with balance billing protection laws in Virginia. As a medical billing company, we can assist healthcare providers in accurately billing for services while ensuring compliance with the balance billing protection law. Our team of experts stays up-to-date with changes in billing and coding regulations, allowing us to provide accurate and timely billing services to our clients.
Additionally, we can assist healthcare providers in verifying patient insurance coverage and providing patients with an estimated cost of service to prevent balance billing. By partnering with Medisys Data Solutions, healthcare providers can focus on providing quality care to their patients while we handle the billing and compliance aspects of their practice. To know more about our billing and coding services in Virginia, contact at info@medisysdata.com / 888-720-8884
