Surprise Billing

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.

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.  

Independent Dispute Resolution Portal Reopened for All Disputes

What’s happening: On Dec. 15, the departments of Health and Human Services, Labor and Treasury reopened the federal independent dispute resolution (IDR) portal for all dispute types.  

What else to know: Dispute types include previously initiated batched disputes, new batched disputes, and new single disputes involving air ambulance services. 

Independent Dispute Resolution Portal Reopening for Certain Disputes

What’s happening: The departments of Health and Human Services, Labor, and Treasury are reopening the independent dispute resolution (IDR) portal for all batched disputes and single air ambulance disputes.  

What else to know: The portal has been closed since federal agencies suspended all IDR process operations in August to align with the district court’s opinions and orders in TMA III and TMA IV.  

Changes Proposed for Independent Dispute Resolution Process

What’s happening: A proposed rule from the departments of Health and Human Services, Labor, and Treasury aims to improve the No Surprises Act (NSA) independent dispute resolution (IDR) process.  

What else to know: Comments on the proposal, which is in response to court rulings that held key provisions of the interim final rules establishing the IDR process impermissible under the NSA, are due Jan. 2.  

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. The rule includes: Provisions related to the independent dispute resolution (IDR) process Good faith estimate for uninsured individuals The patient-provider dispute resolution process The rule also requires IDR entities […]

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.   Beginning on Jan. 1, 2022, the Act, among other things, prohibits balance billing by limiting cost sharing to the in-network amount for:   The interim final rule:  CHA is hosting a webinar on August 6 to discuss implementation of the No Surprises […]