About Surprise Billing
The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills for most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. While California hospitals are already leaders in ensuring patients understand their out-of-pocket costs and offering clear, written discount and charity care policies to help certain patients, new AHA guidelines are a way for hospitals to reinforce their commitment.
HHS Issues FAQs Extending Enforcement Discretion for Certain IDR Disputes
What’s happening: The Departments of Labor, Health and Human Services, and Treasury (the departments) issued new frequently asked questions (FAQs) related to enforcement discretion for certain disputes under the No Surprises Act.
What else to know: The FAQs are in response to the Aug. 24, 2023, decision in Texas Medical Association et al. v. United States Department of Health and Human Services et al. (TMA III) case.
New Process Released for Resubmitting Certain IDR Disputes
What’s happening: The Departments of Health and Human Services, Labor, and the Treasury announced the release of a new process for resubmitting independent dispute resolution (IDR) disputes that were originally improperly batched or bundled.
What else to know: The new resubmission process is automated in the federal IDR portal.
CMS Releases Data on No Surprises Act Payment Disputes
What’s happening: The Centers for Medicare & Medicaid Services released publicly available independent dispute resolution (IDR) reports for the first two quarters of reporting year 2023.
What else to know: The report includes certain data submitted by disputing parties and certified IDR entities to the No Surprises Act (NSA) federal IDR portal.
No Surprises Act: Dispute Resolution Process and Self-Pay Estimates
On September 30th, The Departments of Health and Human Services (HHS), Labor, and Treasury released an interim final rule (IFR) providing additional regulations implementing the No Surprises Act.
No Surprises Act: Implementation for California Hospitals
On July 1, the Departments of Health and Human Services, Labor, and Treasury (tri-agencies) released an interim final rule implementing the No Surprises Act.
No Surprises Act — Hospital Contracting and Compliance Implications
The No Surprises Act was signed into law on Dec. 27, 2020, as part of the Consolidated Appropriations Act of 2021. It addresses surprise medical billing for federally-regulated plans and in states without surprise billing laws. Most sections of the legislation are effective Jan. 1, 2022. As the name implies, this Act prohibits patients from getting surprise bills in certain out-of-network situations. The Departments of Health & Human Services, Treasury and Labor will issue regulations and guidance to implement numerous provisions.