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The No Surprises Act and Surprise Billing Regulations

October 19, 2021

The No Surprises Act was signed into law on December 27, 2020 as part of the Consolidated Appropriations Act, 2021. The Act and associated regulations outline new requirements and processes for health care providers, health care facilities, and health care plans when submitting certain out-of-network plans. Effective January 1, 2022, certain billing practices related to surprise medical bills are prohibited.

What is a surprise medical bill?

A surprise medical bill occurs when a patient receives a bill that is higher than expected due to unknowingly receiving care from an out-of-network provider at an in network facility.

What is changing?

  • Out-of-network Health care providers providing certain emergency and non-emergency health care services at in network facilities will be prohibited from billing patients for surprise medical bills – patients will only be responsible for the applicable in-network cost sharing amounts unless an exception applies.
  • Health benefit plans will be required to cover emergency services without any prior authorization and regardless of whether a provider or facility is in-network.
  • Disputes regarding reimbursement will be resolved through a new dispute resolution process.
  • Health care providers and insurance plans will be required to provide good faith price estimates as well as new notices and disclosures.

What do I need to do next?

Ensure that you and your practice are in compliance with all of the new requirements before the January 1, 2022 deadline and stay informed of any additional rules and guidance. The No Surprises Act directs various federal agencies to publish rules implementing the new requirements. So far, the U.S. Department of Health and Human Services, Department of Labor, and Department of the Treasury have issued two interim final rules: Requirements Related to Surprise Billing: Part I and Requirements Related to Surprise Billing: Part II. Weaver Johnston & Nelson, PLLC will be providing summaries and updates regarding these changes and as more guidance becomes available. For questions about the No Surprises Act or assistance with implementing these new requirements, contact Chris Reed at creed@weaverjohnston.com.