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United States: A New Federal Umpire: What Healthcare Providers Need To Know About Surprise Medical Billing Under The No Surprises Act

A recent study found that, for people in large employer health plans, 18% of emergency visits and 16% of in-network inpatient admissions result in at least one out-of-network charge. Starting next year, however, plans, healthcare facilities, laboratories, medical transportation providers, and other healthcare providers will have to comply with a complex set of new federal requirements designed to protect patients from “surprise medical bills.”

Although the concept of holding patients harmless from unanticipated out-of-network medical bills became a national policy priority with bipartisan interest in 2019, it took nearly two years for comprehensive surprise billing reform legislation to get across the finish line. Included as part of the Consolidated Appropriations Act of 2021 , 1 omnibus legislation signed into law at the end of 2020, the “No Surprises Act” (Act) contains a number of protections for patients in cases of both emergency services and non-emergency services performed by out-of-network providers at in-network facilities. 2 The new law applies to individual and group health plans, including fully-insured plans sold through the individual and group markets, as well as self-funded plans (also known as “ERISA” plans). Below are some of the major elements of the No Surprises Act that may impact your […]

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