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.
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.
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.
The departments of Health and Human Services, Labor, and the Treasury (the departments) have updated guidance regarding the No Surprises Act independent dispute resolution (IDR) process. The departments have directed certified IDR entities to resume processing all single and bundled disputes submitted on or before Aug. 3, 2023.
The Centers for Medicare & Medicaid Services (CMS) will host a webinar to provide an overview of new patient protections and rights under the No Surprises Act.
For the third time, the U.S. District Court for the Eastern District of Texas ruled to set aside certain regulations implementing the No Surprises Act. The Texas Medical Association, joined by several air ambulance providers and supported by an amicus brief filed by the American Hospital Association, successfully argued that the methodology used to calculate the qualifying payment amount (QPA) favors insurers during the arbitration process.
The departments of Health and Human Services, Labor and the Treasury have released frequently asked questions (FAQs) regarding the No Surprises Act independent dispute resolution (IDR) administrative fee. The FAQs are in response to the Texas Medical Association v. United States Department of Health and Human Services opinion and order to vacate the established $350 administrative fee.
On Aug. 3, the Centers for Medicare & Medicaid Services (CMS) suspended the independent dispute resolution process.
On July 7, the Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight issued the new No Surprises Act (NSA) frequently asked questions (FAQs). While the FAQs cover several topics, most importantly, they clarify that “facility fees” are included in the definition of “items and services” for purposes of the machine-readable file that health plans are required to post under the NSA’s Transparency in Coverage provisions and the provider uninsured good faith estimate requirements.
The Centers for Medicare & Medicaid Services has created a web page for consumers on patient protections from unexpected out-of-network medical bills under the No Surprises Act.