Surprise Billing Rules

On September 30, 2021, HHS issued a supplement to Part I of the Surprise Billing Rules called “Requirements Related to Surprise Billing; Part II.” These rules were issued pursuant to the No Surprises Act, which is a part of the Consolidated Appropriations Act, 2021, and took effect for health care providers and facilities on January 1, 2022.

Part II of the Surprise Billing saga provides additional protections against surprise and balance billing by providers. In part, the new rule:

  • Creates an independent dispute resolution process to determine out-of-network payment amounts.
  • Requires the issuance of good faith estimates for items or services provided to individuals who are uninsured or self-pay.
  • Institutes a dispute resolution process between patients and providers or facilities to determine amounts owed.

Part II leaves you with a lot to do. Some of the things you need to consider, and act on, include:

  • Good faith estimates: when they are needed, what they include, and how to draft them.
  • The effect of the independent dispute resolution process on future dealings between providers or facilities and health plans and the effect it will have on negotiations.
  • How to draft a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before you can bill at a higher out-of-network rate.

Attorney Mary Paterni can determine what you need to act on now to make sure you’re in compliance. Contact Mary to find out how she can help you today!