In December 2020, Congress passed sweeping legislation to protect patients from excessive surprise medical bills. The law, commonly referred to as the No Surprises Act (NSA), partially went into effect at the beginning of 2022 and is best known for prohibitions on certain billing practices. The law also establishes a federal independent dispute resolution (IDR) process to settle billing disputes between clinicians and insurers when no state law is in place to govern the dispute. These provisions are intended to take patients out of the middle of these disagreements.
The legislation included other provisions intended to better inform patients about what costs to expect and their rights under the law. For instance, providers are expected to post disclosures in offices and on websites, provide patients with a notice of their rights under the law, and must offer good faith estimates (GFEs) in certain circumstances regarding how much will be billed for a service.
Implementation of the NSA has been problematic thus far, with certain provisions implemented in a manner that seems inconsistent with the legislative language. This discrepancy has led to critical comments, complaints, and even lawsuits from stakeholders likely to be adversely affected by the law. The federal entities tasked with implementing the law have also missed key rulemaking deadlines that have led to inconsistent application of the statute. For example, some provisions obligating health plans to ensure greater transparency for patients have thus far not been implemented.
Furthermore, provisions of the law defer to the states when they have passed their own surprise billing legislation, meaning that surgeons may have slightly different processes for complying with the law or seeking dispute resolution over payments depending on where they practice. Several states are considering new legislation that would affect how the law is enforced in their jurisdiction.
This page is intended to help surgeons comply with the basic requirements of the law related to necessary disclosures, notices to patients, and production of GFEs. It is important to remember that parts of these provisions are required of you even in scenarios where you are not attempting to balance bill a patient, Although not exhaustive, it should guide surgeons seeking to ensure they are compliant with federal and state laws related to surprise billing. Please follow the links to the left to learn more about specific provisions of the new law including:
The patient protections in the No Surprises Act (NSA) essentially stem from two scenarios:
Patient protections included to address the above scenarios:
Impact of Specified State Laws addressing surprise billing:
Qualifying Payment Amount (QPA):
Federal Independent Dispute Resolution (IDR) Process: