New Surprise Billing Requirements
The No Surprises Act prohibits nonparticipating providers and emergency facilities from billing patients for more than their applicable cost-sharing amounts for certain services, also known as balance billing. The prohibitions on balance billing and cost-sharing protections vary among providers depending on the type of services they furnish and their practice settings. The Centers for Medicare & Medicaid Services (CMS) has released Frequently Asked Questions (FAQs) on the No Surprises Act implementation, providing details about balance billing and notice and consent prohibitions. We shared new surprise billing requirements for reference only.
The Consolidated Appropriations Act of 2021 established several new requirements to protect consumers from surprise medical billing. These requirements are collectively referred to as “No Surprises” rules. These requirements generally apply to items and services provided to consumers enrolled in group health plans, group or individual health insurance coverage, and Federal Employees Health Benefits plans. Patients now have new billing protections when getting emergency care, certain non-emergency care from out-of-network providers during visits to certain in-network facilities, and air ambulance services from out-of-network providers.
A provider or facility must disclose to any participant, beneficiary, or enrollee in a group health plan or group or individual health insurance coverage to whom the provider or facility furnishes items and services information regarding federal and state (if applicable) balance billing protections and how to report violations.
Providers or facilities must post this information prominently at the location of the facility if the location is publicly accessible, post it on a public website (if applicable), and provide it to the participant, beneficiary or enrollee no later than the date and time on which the provider or facility requests payment from the individual or, with respect to an individual from whom the provider or facility does not request payment, no later than the date on which the provider or facility submits a claim to the group health plan or health insurance issuer.
Generally, the No Surprises protections apply to individuals enrolled in a health care plan, through an employer (whether self-funded or insured, including coverage offered by federal, state, or local governments, or a multiemployer plan), or through the federal Marketplaces, state-based Marketplaces, or directly through an individual market health insurance issuer. The rules don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE.
We shared crucial information about the No Surprises Act (NSA), new surprise billing requirements, balance billing, and good faith estimate for reference purposes only; you can refer to the following link for detailed information about no surprises rule. Medisys Data Solutions is a leading medical billing company providing complete assistance in medical billing and coding. If you need any assistance in billing, contact us at This email address is being protected from spambots. You need JavaScript enabled to view it./ 302-261-9187.