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View More HealthExecStore Webcasts and Conferences

Making Sense of the No Surprises Act and Interim Final Rules

HealthExecStore

Nov. 9, 2021
Recorded Online
Webcast
  • Key components of the No Surprises Act, and subsequent Interim Final Rules
  • Specific and “operationalized” guidance on complying with the Act
  • Interaction of the Act with state balance billing laws
  • Impact and scope of the Act on billing for ancillary services provided outside of, but associated with, a hospital visit
  • Business opportunities emerging from implementation of the Act

Faculty: Helaine I. Fingold, Member of the Firm, Epstein Becker Green, and Robert (Bob) R. Hearn, Member of the Firm, Epstein Becker Green

The No Surprises Act, included within the Consolidated Appropriations Act, a massive piece of COVID-19 relief legislation signed into law in late 2020, is set to become effective January 1, 2022.  While the laudable goal of the Act is to protect patients from surprise billing, the law and its associated rules will also impose significant compliance burdens on health plans, providers, and facilities with regard to their patient billing and claims submission processes, as well as with respect to making novel patient and plan billing rights disclosures and meeting the Act’s unprecedented price transparency requirements.  The requirements of the No Surprises Act are complicated by their complex interaction with an inconsistent and confusing patchwork of state laws and administrative rules on the same subject.

With two Interim Final Rules and one Proposed Rule issued for the No Surprises Act, there is now detailed information available for health plans and providers to digest in order to best prepare for January 1, 2022 compliance with the law. In July 2021, the Administration released the Interim Final Rule for the No Surprises Act: “Requirements Related to Surprise Billing; Part I, addressing:

  • Definitions critical to the Act’s application, including what constitutes emergency and post-stabilization care;
  • The specifics of the billing prohibitions applicable to providers and facilities;
  • The Act’s application to ancillary service providers;
  • Billing rights disclosures; and
  • The mechanics of the Act’s various notice and consent processes;

The Interim Final Rule for the No Surprises Act: “Requirements Related to Surprise Billing; Part II,” was issued at the send of September 2021, and includes the following provisions:

  • A process that takes consumers out of the middle of a payment dispute between out-of-network providers and health plans;
  • Requirements for providing health care cost estimates to uninsured (or self-pay, meaning you have coverage but choose not to have your care billed to your health plan) individuals;
  • A payment dispute resolution process for uninsured (or self-pay) individuals; and
  • Expanded rights to external review (what individuals with job-based or individual health plans can use to dispute when certain claims are denied payment, as described below).

Earlier in September, the Administration released a Proposed Rule addressing data reporting requirements on the air ambulance provider industry and other disclosure and enforcement provisions.

With the January 1, 2022, implementation deadline approaching rapidly, health plans, health care facilities, providers, and ancillary service entities that support hospital in-patient, out-patient, and emergency operations are scrambling to figure out what the new federal law and its implementing rules means for them.

In this session, Epstein Becker Green’s Helaine Fingold and Bob Hearn help to make sense of the Act, examine the business opportunities and solutions that exist despite the high-stakes legal, policy, and regulatory issues that the health care industry faces, and discuss specific and “operationalized” guidance to providers, facilities, and health plans on complying with the Act, including its challenging interaction with state balance billing laws. Their insights are based on experience in this arena and are rededicated to deciphering the complex interaction between state law and the new federal law.

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