decisionhealth Newsletters, Part B News - 2022 Issue 8 (August)
Directory glitch caused patient overcharge? Under NSA, you pay, not the plan
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Article Overview
This article discusses No Surprises Act and CMS guidance on provider directory accuracy, how responsibilities are shared between health plans and providers, and what happens when a patient receives out-of-network care because directory information was wrong. It is aimed at billing, revenue cycle, compliance, and provider office staff who need a broad understanding of directory maintenance obligations, refund responsibility, and related dispute considerations under federal guidance.
Why This Topic Matters
Accurate provider directory data affects patient billing, network status communication, and the handling of overpayments tied to inadvertent out-of-network care. Understanding the shared responsibilities under the No Surprises Act helps organizations reduce payment disputes and compliance risk.
What You Will Learn
- How the No Surprises Act addresses provider directory accuracy
- How directory maintenance responsibilities are described for plans and providers
- What general issues arise when inaccurate network information leads to patient overcharges
- How related CMS guidance and federal law frame refund and dispute considerations
- Why internal processes for timely directory updates matter for compliance
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle staff
- Compliance staff
- Practice managers
- Provider office administrators
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