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Surprise Billing Basics

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Health related documents and legislation may be some of the most complex types of writing, filled with legalese and seemingly endless sentences. When these two topics are combined it can feel overwhelming, with patients caught in the middle of payors and providers claiming payment. Come January 2022, that’s no longer going to be okay with Health and Human Services. This latest step towards protection from financial transparency and surprise medical bills may seem daunting to understand, so we’ve laid out the basics, including how CMT Solutions can help providers, payors, and patients alike with seeQer – an Advanced Explanation of Benefits tool.

Surprise Billing Basics infographics

How CMT Can Help

CMT has integrated solutions and platforms that give laboratories and physicians a Good Faith Estimate and an AEoB tool that understands a patient’s insurance benefits, out-of-pocket cost, and health plan policy: seeQer. Features included with seeQer are designed to provide solutions for the new Surprise Billing Legislation and answer the following common questions:

  • What are the Patient’s Insurance Eligibility and Benefits?
  • What is the Health plan’s Coverage and Medical Policy of the Service or Test?
  • What is the Patient’s and Health Plan’s Financial Responsibility for this test?
  • What Medical Management is Required?

seeQer can provide these answers in real time through our single platform tool for the ordering physician, facility, lab, or health plan. CMT’s vision is to improve patient access to care and remove barriers to diagnostic testing and healthcare through a sustainable solution that efficiently navigates the complex landscape involving payors, laboratories, physicians, and the patient. 

Resources:
American Hospital Association, Legislative Advisory
Centers for Medicare and Medicaid Services: What You Need to Know about the Biden-Harris Administration’s Actions to Prevent Surprise Billing
Centers for Medicare and Medicaid Services: Requirements Related to Surprise Billing; Part I Interim Final Rule with Comment Period
CNBC: This is the real reason most Americans file for bankruptcy


About CMT

CMT offers combined expertise in laboratory, technology solutions, and HUB services to help both patients and physicians. It is the market leader in molecular diagnostic patient access, offering prior authorizations, benefits investigation, notifications, genetic counseling, and more.

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