QUESTION:
I heard that the Government might delay the implementation of the Surprise Billing Rules that are scheduled to go into effect on January 1, 2022.  Is that so?

ANSWER:
Partially.  On July 13, 2021, the Departments of Health and Human Services, Labor, and Treasury published an Interim Final Rule implementing certain provisions of the No Surprises Act, which was enacted as part of the Consolidated Provisions Act of 2021.  Effective January 1, 2022, the Interim Final Rule:

• affords patients protection against balance billing and cost sharing for certain out-of-network services;

• prohibits out-of-network providers and health care facilities from balance billing patients under specific circumstances absent notice and consent;

• requires providers to disclose federal and state patient protections against balance billing; and

• describes complaint and dispute resolution processes for patients, payers and providers to address potential violations.

In an FAQ published on August 20, 2021, HHS said it will defer enforcement of the requirements to (1) make public the machine-readable files for in-network rates and out-of-network allowed amounts and billed charges, (2) provide good faith estimate of expected charges, and (3) provide an Advanced Explanation of Benefits at least until July 1, 2022.  https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-49.pdf

So, the bottom line is that the regulations are still scheduled to go into effect on January 1, 2022, but certain parts will not be enforced right away.

In the meantime, hospitals should begin to check their physician contracts, especially those with hospital-based providers like radiology, pathology, anesthesia and emergency medicine, to make sure they require the physicians to comply with the surprise billing rules and preferably require them to participate in any third-party payor programs in which the hospital participates.

Horty Springer and its partner LegalSifter will soon be announcing a new AI-empowered tool to make it easier to review your contracts for Surprise Billing compliance. Be sure to watch for it!