On 28 December 2020, the federal No Surprises Act (Act)1 was enacted. The Act seeks to protect patients from so-called “surprise medical bills” in certain emergency and nonemergency settings for out-of-network patients. This alert focuses on the Act’s arbitration provisions but first provides necessary background to those provisions.
Read moreSurprise Medical Billing – Changes to Law Will Have a Significant Impact on Group Health Plans
On December 21, 2020, Congress passed the Consolidated Appropriations Act, 2021, which included a $900 billion COVID-19 relief and stimulus package and a new set of rules intended to address “surprise” medical billing. The No Surprises Act (the “Act”), which is part of the 2021 appropriations act, makes various changes to ERISA that are intended to ban the practice of “surprise” medical bills, which arise when a person covered by a group health plan unexpectedly receives emergency medical care from an out-of-network provider at an out-of-network facility or from an out-of-network provider at an in-network facility. In these instances, the out-of-network provider can bill the person for the difference between their charged rate and the amount an employer’s group health plan (or the insurer) agrees to pay, which is known as “balance billing.” The Act takes several steps to address this situation.
Read moreThe Federal No Surprises Act and Its Arbitration Provisions
On 28 December 2020, the federal No Surprises Act (Act)1 was enacted. The Act seeks to protect patients from so-called “surprise medical bills” in certain emergency and nonemergency settings for out-of-network patients. This alert focuses on the Act’s arbitration provisions but first provides necessary background to those provisions.
Read moreNew COVID-19 Bill Puts Kibosh on Surprise Medical Billing Beginning in 2022
On December 27, 2020, the Consolidated Appropriations Act, 2021, was signed into law. The Act included a measure entitled the “No Surprises Act” to restrict medical providers from sending consumers surprise medical bills.
Once the Act goes into effect in 2022, consumers will not receive balance bills for the following:
Emergency care;
Transport by air ambulance; or
Non-emergency care at an in-network facility, when patients are unknowingly treated by an out-of-network doctor or lab
In these situations, consumers would only be responsible for paying their deductibles and co-payments per the terms of their in-network health insurance plans. Under the Act, medical providers are prohibited from making patients responsible for the difference between their deductibles/co-payments and any higher fees that the provider wants to charge.
Read moreUnderstanding 2021 Changes in Emergency Medicine Reimbursement
Emergency medicine groups face several changes this year, including a new federal ban on surprise medical billing, updates to the Medicare reimbursement formula, changes to the CMS MIPS program, and new billable services. Below is a summary of these changes provided by the experts at Brault Practice Solutions.
Read moreThe No Surprises Act: Implications for Health Plans, Health Care Facilities, and Health Care Providers
Following months of congressional negotiations, on December 27, 2020, President Trump signed into law the Consolidated Appropriations Act, 2021, a $2.3 trillion piece of legislation that includes $900 billion in federal funding and relief for COVID-19.[1] The legislation also includes the No Surprises Act (“Act”), effective January 1, 2022, which significantly bolsters consumer protections for patients by addressing the circumstance of patients receiving “surprise bills” for health care services.[2] While we expect the Biden administration to issue regulations implementing the Act within the next year, stakeholders should be aware of the Act’s many new obligations on health plans,[3] health care facilities, and health care providers.
Read moreSurprise Medical Billing Protections Coming for Participants in 2022
Beginning in 2022, employer-sponsored health plans will be required to pay providers certain emergency and out-of-network charges that would have otherwise been balance billed to participants.
That is the centerpiece of the No Surprises Act, part of the sprawling Consolidated Appropriations Act, 2021, which was signed into law by President Donald Trump on December 27, 2020.
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