What to Expect from the No Surprise Act
Gain an understanding of surprises balance billing, the problems it causes, and the ways the No Surprises Act attempts to address those problems.
This topic is designed to explain the No Surprises Act, including its history, the important problems the Act tries to solve, and how it attempts to solve those problems. Surprise balance billing has been a hot-button issue in state and federal politics for many years. The No Surprises Act radically changes the status quo for health plans, health care providers, and patients with respect to out-of-network care for emergency services, non-emergent services provided by out-of-network providers at in-network facilities, and air ambulance services. The Act goes into effect on January 1, 2022. Health care providers may be subject to steep fines if they impermissibly balance bill patients, and they may be unable to collect additional payment if they do not comply with specific requirements to submit claims to arbitration. Health plans are regulated in new ways that may impose additional financial liability for out-of-network claims. This material will provide you and understanding of the new requirements, challenges of implanting the Act, and strategies to adapt to the new way of paying for these out-of-network services.
• You will be able to describe how the dispute resolution process created by the No Surprises Act will work.
• You will be able to discuss surprises balance billing, including the problems it causes, and the ways the No Surprises Act attempts to address those problems.
• You will be able to explain how the No Surprises Act alters the way in which payment for certain out-of-network services is determined.
• You will be able to identify the out-of-network situations to which the No Surprises Act applies.